Hypothenar hammer syndrome is an underdiagnosed disorder that classically has been associated with repetitive occupational trauma. However, a substantial portion of cases can arise from recreational activities or a single acute event. A 15-year-old drummer presented with a 6-month history of a bulge over the hypothenar eminence of his left palm. An angiogram showed a 1.5 x 2.0 cm pseudoaneurysm arising from the ulnar artery just distal to the deep palmar branch and extending into the proximal portion of the superficial palmar arch. The aneurysm was resected and reconstructed with a primary end-to-end anastomosis. The symptoms of hypothenar hammer syndrome are variable and can be related to poor inflow, distal spasm, or emboli. Careful history and physical examination with consideration of anatomical relationships will reveal the diagnosis. Recommendations for further diagnostic testing and specific treatment strategy vary owing to increased understanding of this syndrome combined with a paucity of controlled studies. Clinical aspects and management of this case are discussed in light of the current literature.
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