"In the past, treatment of hypothenar hammer syndrome has been controversial, and physicians have been searching for some way to treat it,” says Craig Johnson, M.D., chair of Mayo Clinic's Division of Plastic Surgery and lead study investigator.
Dr. Johnson explains that symptoms improved in 78 percent of the patients in his study who underwent a bypass grafting operation and that he witnesses an almost immediate relief in his patients with this surgery.
"Post-surgery, patients feel their hands are warmer right away, though ulcers take a little longer to heal,” he says. "Most people do quite well and get back to work quickly.”
Dr. Johnson studied 115 hands in 101 patients evaluated at Mayo Clinic. Medical and surgical treatment options pursued were evaluated by chart review and postoperative phone calls for all patients, and by duplex scan, an ultrasound of the arteries that measures blood flow, for those who underwent bypass surgery.
An average of 3.5 years post-treatment, 29 of the 41 patients treated with medication or sympathectomy showed no change in symptoms, seven were worse and five showed symptom improvement.
Two types of excision operations were used for the remaining 60 patients studied. Four received excision of the damaged portion of the ulnar artery or surrounding vessels followed by ligation, or binding; symptoms in three out of four of these patients were unchanged post-surgery.
The other 56 patients were treated with surgical excision of the damaged ulnar artery or surrounding vessels followed by bypass grafting; 78 percent of these patients improved, losing their pain and cold intolerance and returning to work.
Of the 22 percent who showed no change or worsening of symptoms following bypass grafting surgery, 86 percent of the patients had continued smoking. Dr. Johnson explains that quitting smoking is key to a lasting effect of the bypass grafting surgery.
MEDICA.de; Source: Mayo Clinic