gms | German Medical Science

Objectives/Interrogation: The incidence of digital ischemia of the hand is rare, although it can arise in athletes participating in baseball, volleyball, and handball.

We describe a professional baseball player with occlusion of both the radial and ulnar arteries secondary to repetitive trauma to the palm of the hand. Open release of the ulnar artery resulted in complete relief and symptomatic improvement.

Methods: A 37-year-old male, a right-hand dominant professional baseball pitcher, presented with pain, cold intolerance and numbness that were aggravated for short periods in the right ulnar digits while pitching. Conservative medical treatment at a local hospital did not adequately improve his symptoms and he was referred to our hospital two weeks after symptom onset. Angiography revealed complete occlusion of the ulnar and radial arteries at the hypothenar and thenar muscles, respectively. Collateral circulation was evident from the radial artery with the flow into the deep palmar arch. Retrograde flow from the radial artery also reached the superficial palmar arch. In addition to chronic radial artery occlusion, we considered that recent ulnar artery occlusion had disturbed blood flow to the finger on the ulnar side.

Surgical revascularization was performed under general anesthesia.

The ulnar artery was compressed by fibrous tissues at two points on the hypothenar muscle. Resection of the fibrous tissues resulted in the resumption of pulsation in the artery. The symptoms immediately disappeared thereafter, and he resumed throwing activities four weeks after the procedure. Within one year of the procedure he was able to return to the mound to pitch in official games.

Results and Conclusions: Thenar and hypothenar hammer syndromes are rare. They are characterized by digital ischemia of the hand as a result of repetitive trauma at the level of the thenar and hypothenar eminence and damage to the radial and ulnar arteries, respectively. Our patient repeatedly placed the palm of his right hand on the ground during daily baseball bunt practice and repeated microforces to the palm apparently caused digital ischemia. Non-surgical treatment is generally considered as a first line. However, this patient was surgically treated because a conservative approach did not achieve symptomatic relief and he wished to resume play as soon as possible.