Nickul N Shah1*, David Roman2 and Roland Purcell3
Interfaith Medical Center, 1545 Atlantic Avenue, Brooklyn NY 11213, USA
Received: 02 November, 2015; Accepted: 17 November, 2015; Published: 19 November, 2015
Nickul N. Shah, Interfaith Medical Center, 1545, Atlantic Avenue, Brooklyn NY 11213, E-mail:
Shah NN, Roman D, Purcell R (2015) Aberrant Ulnar Artery and Ulnar Artery Thrombosis with Nerve Entrapment: A Case Report. J Surg Surgical Res 1(3): 072-075. 10.17352/2455-2968.000017
© 2015 Shah NN et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Ulnar artery thrombosis; Ulnar nerve compression; Superficial ulnar artery
Introduction: Vascular compromise causes hand pain, and physical examination requires to differentiate vascular causes from isolated ulnar nerve compression. Diagnostic studies visualize vascular abnormalities such as CT scans, MRA scans, and AV fistulograms. Ulnar artery aneurysms are quite rare discoveries, related to repetitive trauma, vasculitis, anatomic abnormalities, or infections. It is essential to repair any aneurysm when flow impediment causes significant symptoms. Blunt injury to the ulnar artery and superficial palmar arch damages the arterial wall and forms an aneurysm. The sensory branch of the ulnar nerve becomes compressed. Treatment here is to resect the thrombotic segment to relieve the compression. It is interesting to note, in this particular case, that a high origin and superficial ulnar artery had coursed along the forearm and entered along the ulnar side of the hand. The presence of such anatomic variations are essential in medical practice.
Case presentation: A 73-year-old Haitian female was admitted to the hospital with complaints of numbness and weakness along the right forearm and wrist. According to the patient’s daughter, she has experienced these symptoms for at least two years’ duration after minimal trauma to her right hand. Upon physical examination of the right wrist, a 3-cm palpable, pulsatile ulnar mass was found. The Allen’s test showed no significant abnormalities, but the Tinel’s test and pinprick examination were diminished. An AV fistulogram was scheduled the same day and a repair followed soon after. IV contrast dye demonstrated an aneurysm of the ulnar artery, along with an adjacent superficial branch. The decision was made to resect the aneurysm and allow the superficial ulnar artery remain patent for continuous blood supply to the 4th and 5th digits of her right hand. She was discharged the same day and to follow up in the vascular clinic a week later.
Conclusion: This particular case describes a couple important disciplines that establishes further insight about the human anatomy, pathophysiology and vascular surgical management. First, hypothenar hammer syndrome has been illustrated in a patient without any history of vasculitis, infections, or congenital anatomic abnormalities. A diagnostic and therapeutic approach is necessary to relieve ulnar nerve entrapment. Second, this particular patient underwent a simple repair but it was found that an aberrant ulnar artery was discovered, which coursed adjacent and superficial to the aneurysm. It is important to establish an early diagnosis prior to any surgical procedures. Intraoperatively, proper identification to isolate and establish a continuous blood flow is essential. Knowledge of such variations allows for improved care in the fields of radiology, angiography, surgery and the medical sciences.
Aneurysmal formations often result from excessive dilatation secondary to damage of blood vessel walls. Aneurysms of the ulnar artery and palmar arch arise from rare circumstances, usually related to repetitive trauma of the upper extremity, which affects the hypothenar region of the hand. As a result, adults can experience hand and finger pain from vascular insufficiency and compression of the ulnar nerve. However, most traumatic aneurysms are quite common among young males, and sometimes related to congenital abnormalities or infections. A Duplex ultrasound and AV Fistulogram identified an aneurysm in a 73-year-old woman after a minor injury. In addition, a superficial ulnar artery of high origin was identified, lying superficial and adjacent to the aneurysm.
A 73-year-old, non-smoker, Haitian woman was accompanied with her daughter to the community hospital. The patient spoke very little English, but her daughter translated. As per her daughter, the patient complained of numbness, pain and weakness along the right arm, forearm, and wrist. She had visited her home in Haiti two years ago, and believed she unintentionally “bumped her hand on something”. The patient has a significant past medical history of hypertension, arthritis of both her hands, bilateral cataracts, and a right sided lumpectomy. Upon examination, she appeared to be well nourished, without apparent distress, was alert and oriented. A 3-cm pulsatile mass was observed at the ulnar side of the right wrist with a palpable thrill. No obvious signs of trauma were observed. She had numbness and tingling along the 4th and 5th digits of her right hand, but strength was preserved. The Allen’s test was conducted, and no significant abnormalities were observed. A Tinel’s test was also conducted, but showed hyporeflexia. Pinprick sensation was also diminished along the ulnar distribution of the hand.
Subsequently, she underwent an AV fistulogram, which demonstrated the dilated vessel and aberrant branch of an ulnar artery. A contrast dye was utilized to isolate the aneurysm and observe the continuity of blood flow. It showed that there was no disruption of flow proximal or distal to the aneurysm as well as the adjacent artery (Figures 1A-1C).