Vascular occulsion Flashcards
What is hypothenar hammer syndrome?
What is the incidence adn risk factors?
Post traumatic digital ischaemia by **thrombosis of **
** ulna artery in Guyon’s canal**
Males 9:1 Females
40-60 yrs
usually dominant hand- ring or little finger, thumb spared
risks: vibration tools, sports- baseball catchers/ golfers
What is the pathology of hypothenar hammer syndrome?
single or repetitive blunt impact to hypothenar eminence -> ulna artery thrombosis or aneursym
Hook of hmate acts an avil for thrombosis
Describe the course of the ulna artery as it exits Guyon’s canal?
It branches into 2 - Superifical and Deep branch
its relationship to the hook of hamate- over distal 2cm, the artery is directly anterior to the hook of the hamate, covered by palmaris brevis, subcutaneous tissue and skin
what are the symptoms and signs of hypothenar hammer syndrome?
What test could you do confirm diagnosis?
Symptoms-
pain over hypothenar eminence and ring finger
cold senstivity
parathesia
Signs:
blanching, mottlying, ulceration
tenderness over hypothenar eminence
prominent callus
pulsatile mass if aneurysm present
Allen’s test- positive if occulsion
What imaging is useful for diagnosis?
What is ths Differential diagnosis for this condition?
Doppler- first line
Angiogram Ct/MRI to confirm occulsion around hook of hamate
Raynaud’s disease- where the thumb is involved not so in hypothenar Hammer syndrome
What is the treatment for Hypothenar hammer syndrome?
Non operative: lifestyle changes- smoking cessation, avoid recurrent trauma= 80% success
Operative= when ischaemis in multiple digits= >
Resection of thrombotic / aneurysmal segment +/- local sympathectomy
Raynaud’s syndrome consists of 2 diseases, name them?
Raynaud’s Disease
Raynaud’s phenomenon
What is the difference between Raynaud’s disease and phenomenon?
Phenomenon= vasospastic disease with a cause/ disease
Disease= vasospastic disease with no cause found
Can you describe the eipdemiology of raynaud’s phenomena?
Describe its pathology and signs?
Women >40
Female predominence
Path: Periodic digital ischemia induced by cold temperature or sympathetic stimuli including pain or emotional stress
Signs- triphasic colour change- white- blue -red
white= due to vasospam
blue to venous statsis
red- rebound hyperaemia
What are the condiiton assocaited with Raynaud’s phenenoma?
Connective tissue disorders-
Scleroderma (80-90%)
SLE (18%-26%)
Dermatomyositis (30%)
RA (10%)
CREST Syndrome= calcinosis, Raynaud’s, Eosphaygeal dysmolitiy, scleroderma, telangectasia
Neurovascular Compression- thoracic oulet syndrome
Are studies helpful in raynaud’s phenomenon?
What is the TX?
Yes often abnormal blood chemistry, microangiology, angiography
Tx Non operative : treat underyling disease
Lifestyle modifications
Are studies helpful in Raynaud’s disease?
How is it tx?
No- normal biochem etc, normal allen’s test, as no underlying diseae is causeative
Tx; Non operative
lifestyle changes, avoid cold temperature, cessation smoking
medication- ca channel blockers, dipyridamole (Persantine),
Surgery- Sympathectomy if consx tx fail
What is Buerger’s disease aka Thromboangitis obliterans?
A nonartherosclerotic, segmental inflammatory disease of small and medium vessels of hands and feet
What is the epidemiology of Buerger’s disease?
What are the risk factors?
Common in smokers
Typically effects patients <45 yrs
Males 3: 1 female
Smoking and chewinf tobacco
What is the pathology of Buerger’s disease?
Inflammation and clotting of the small vessels of hand and feet
3 Phases
Acute- thrombus including neutophils occlud vessel lumen sparing wall.
Subacute- organisaiton of the thrombus
Chronic- inflammation subsides- organised thrombus and fibrosis remains