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Hypothenar hammer Syndrome (HHS) is a condition characterised by digital ischaemia as a result of repetitive trauma to the hypothenar eminence of the hand. It occurs in people who repeatedly use the palm of the hand as a hammer to push, grind or twist objects. It is a curable and a preventable cause of upper digital ischemia. In this report we present a case of HHS and discuss the causes and pathogenesis of this syndrome. We review the incidence, clinical characteristics, differential diagnosis, investigation and treatment.

Introduction Elbow arterio-venous fistulas (AVFs) may lead to debilitating hand ischaemia, even after several years of successful haemodialysis. If impaired arterial inflow is identified as the cause of ischaemia, endovascular techniques are usually successful in restoring hand perfusion. Report This paper reports of a patient with severe haemodialysis access-induced distal ischaemia (HAIDI) due to subclavian artery occlusion 5 years after AVF construction. As both endovascular and open carotid or subclavian surgical techniques were contraindicated, recovery from hand ischaemia was achieved by the use of a femoro-axillary bypass graft. Discussion The common femoral artery is a viable alternative inflow location for bypass grafting in HAIDI if commonly used upper body arterial sources are less suitable or unavailable.