OasisLMS

A 40-year-old right-hand-dominant welder presented with a 2-week history of a painful mass over his left hypothenar eminence, without weakness, sensory changes, skin changes, or cold sensitivity. Examination showed a tender hypothenar mass, normal neurologic findings, and well-perfused digits, but a positive Allen’s test and Doppler evidence of compromised ulnar artery flow, while MRI demonstrated a tortuous ulnar artery with aneurysmal dilation exerting mass effect on the ulnar nerve. Hypercoagulable workup was normal. Given that his symptoms were from local mass effect rather than digital ischemia, he underwent surgical excision of the aneurysmal ulnar artery segment with thrombectomy of the superficial palmar arch, followed by ligation of the proximal and distal ulnar artery stumps without vascular reconstruction.

Intended Audience:

This educational activity is intended for plastic surgery practitioners, residents, and other healthcare professionals interested in translating expanded knowledge into practice for the improvement of patient outcomes in plastic and reconstructive surgery.

Learning Objectives:

By the end of this activity, participants will be able to: 

1. Recognize the clinical presentation and key physical exam findings of hypothenar hammer syndrome, including cases that present with a hypothenar mass and intact digital perfusion rather than overt ischemia.
2. Interpret relevant imaging and vascular studies (Doppler, Allen’s test, MRI/angiography) to differentiate aneurysmal ulnar artery pathology with mass effect from other causes of ulnar-sided hand pain or neuropathy.
3. Formulate an operative plan for hypothenar hammer syndrome that balances excision, thrombectomy, and options for ulnar artery ligation versus reconstruction based on collateral circulation and the presence or absence of ischemic symptoms.

Jessica Frankenhoff, MD

Jillian McLaughlin, MD

• Patient Care
• Medical Knowledge
• Practice-based Learning and Improvement

Not for AMA PRA Category 1 Credits ^TM

Media: Multimedia

Release Date:  12/8/2025

Expiration Date: 12/8/2028

Estimated time to complete this course: 30 minutes

*Course access ends on course expiration date

Directly provided by the American Society of Plastic Surgeons® (ASPS®)