Hypothenar Hammer Syndrome masquerading as Raynaud's syndrome: case report and literature review.

A 48-year-old male was referred to Rheumatology clinic with diagnosis of Raynaud's syndrome from his primary care physician. He complained of pain and decreased temperature in the right 4th finger. There was no pain or decreased temperature in any of the other fingers. No symptoms of connective tissue disease. On examination, he had good radial, ulnar, and brachial pulses bilaterally. The right 4th finger was cool and pale. The rest of the physical examination was unremarkable, specifically no stigmata of connective tissue disease. Outside lab tests were normal including a negative ANA and a normal sedimentation rate. Angiography was done and showed dissipated ulnar artery flow beyond the level of the right wrist compatible with Hypothenar Hammer Syndrome. Patient's occupation involved removing and replacing hubcaps on automobile tires, and he frequently used the palm of his right hand as a hammer instead of the usual rubber mallet. A literature review is presented. The lesson of this case is that a male who presents with a unilateral, cold finger needs a detailed occupational history that should include specific questioning on the use of the affected hand as a tool. Hypothenar Hammer Syndrome is probably more likely than Raynaud's in this clinical setting.

Stephen Bagg, BA, and Leonard Serebro, MD. MUSC School of Medicine, Charleston, SC. Ochsner Clinic Foundation, New Orleans, LA.