Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

Featured on Channel NewsAsia

Hypothenar Syndrome

SYMPTOMS

There is pain and a sensation of cold in the fingers. Often sleep is disturbed by pain. It is common in martial arts and lacrosse.

AETIOLOGY

These symptoms are caused by spasm, thrombosis or aneurysm in the ulna artery in Guyon’s canal.

CLINICAL FINDINGS

There may be an ulceration of a distal finger tip and swelling around the base of the palm. Allen’s test is positive.

INVESTIGATIONS

Radiological intravenous investigation verifies the type and size of the blockage of the artery.

TREATMENT

The cause for the onset should be found and addressed, possibly with better protection against direct trauma, bracing or changes in technique. Surgery may be required in severe cases.

REFERRALS

Refer to hand specialist or vascular surgeon if there is long duration of progressive symptoms or if the diagnosis is not clear.

EXERCISE PRESCRIPTION

Most sports can be maintained but avoid direct impact to Guyon’s canal area. After surgery the symptoms are usually relieved almost immediately and most activities can be back to normal within six weeks. Running, cycling and swimming (when the wound is healed
after surgery) are good alternatives to keep up general fitness. Gym training can be maintained.

EVALUATION OF TREATMENT OUTCOMES

Normal clinical symptoms and signs and negative Allen’s sign.

DIFFERENTIAL DIAGNOSES

This is a difficult but clear clinical diagnosis.

PROGNOSIS

Excellent-Good in most cases.

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