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Upper Limb Injury
Hypothenar hammer syndrome in a middle blocker – case report and brief review
  1. M Massada,
  2. R Aido,
  3. C Magalhaes,
  4. N Puga
  1. Portuguese Volleyball Federation, Porto, Japan
  1. Email: martamassada{at}


Background Hypothenar hammer syndrome (HHS) is an uncommon vascular overuse syndrome caused by trauma to the palmar portion of the ulnar artery.

Objective In this report, we describe a representative case in the volleyball player as well as a brief approach to clinical features, pathogenesis, diagnosis, imaging and management.

Design Case report.

Setting Volleyball National Team.

Methods The athlete is a 22-year-old right-hand dominant male, national team middle blocker, who presented to the Medical Department for evaluation of painful and paresthetic fourth and fifth digits. He described the affected fingertips and hypothenar region as being tender and sensitive to touch. When queried, he stated that he would use the hypothenar portion of his right hand to spike and block. There was an abnormal Allen test in the right hand with refill of the palmar vasculature with release of the radial artery but no refill with release of the ulnar artery, consistent with a diagnosis of HHS. He started a platelet aggregation inhibitor and was instructed and trained to change his hitting technique.

Results On follow-up the athlete's remaining symptom was mild cold sensitivity. He was able to perform his usual sports activities without impairment.

Conclusions Typically, HHS occurs in men in their 40s involving the dominant hand and in occupational settings where the workers use the hypothenar portion of the hand as a tool to hammer, push or squeeze hard objects (metal workers, machinists, brick layers, carpenters, etc.). It is a curable and preventable cause of upper extremity digital ischemia, rarely seen in volleyball.

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