The Importance of Timely Diagnosis and Good Medical Teamwork; an Interesting Recent Case
Gregory Horner, M.D.

Many people who work with their hands develop painful problems such as tendonitis or joint pain. Usually they are treated by their family doctor, or in a workers’ injury clinic.  Most of these medical ailments are effectively treated in these settings.  However, there may be warning signs that suggest a limb-threatening disease may be present.  A recent interesting case in our office represents one such example.

A middle-aged man felt pain on the small finger half of his hand.  The ring and small finger were "going numb."  Later, he reported to his primary treating doctor that the ring finger had turned blue.  Within days, the tip of the finger had ulcerated.  After reporting this to his primary doctor, he was promptly referred to our Tri-Valley Orthopedic Specialists (TVO) Hand Clinic and was seen immediately. 

"You are experiencing HYPOTHENAR HAMMER SYNDROME," I told him.   "That’s’s a fancy medical name for a clot in the artery to the hand," I added.  "It is caused by the action of using the hand like a hammer, such as to 'fix' a TV."

This syndrome is much like a heart attack for the hand. It is not uncommon for patients to lose some or all of the hand with this disease.  Once the warning signs are identified, it is critical that treatment by experienced Hand Microsurgeons be sought. 

"The clot was actually extending into the fingers!" remarked radiologist Christopher Tran, M.D., at ValleyCare Medical Center in Pleasanton.  He added, "This is an example of excellent teamwork in our local medical community."

Dr. Tran and I made use of a new diagnostic tool which confirmed the diagnosis and helped make the surgical plan crystal clear.  

These surgical cases require the surgeon to operate using a microscope ("microvascular surgery" is the term we use).  Generally, a team of surgeons is required who must be available for care after the surgery, to be on the lookout for a recurrent blood clot.  In this case, I was ably assisted by Alexandra Burgar, M.D., my fellow TVO hand surgeon and microvascular expert. 

The patient has enjoyed a smooth recovery and is quickly regaining full function of his hand.  "I’m really happy that Dr. Horner was able to see me that day", he exclaimed at a follow-up visit six weeks later.  "You know, he was able to make the diagnosis immediately.  After he explained the problem, I really understood what was going on. 

I can’t begin to tell you how much of a relief that was."