Introduction. The hypothenar hammer syndrome is a rare traumatic vascular disease of the hand. Method and Materials. We report the case of a 43-years-old man with a painful tumefaction of the left hypothenar region. The ulnar artery appeared thrombosed clinically and radiologically. The patient underwent surgery to resolve the ulnar nerve compression and revascularise the artery. Results. The symptoms disappeared immediately after surgery. The arterial flow was reestablished. Postoperatively on day 20, a new thrombosis of the ulnar artery occurred. Conclusion. Hypothenar hammer syndrome is caused by repetitive trauma to the heel of the hand. The alterations of the vessel due to its chronic inflammation caused an acute compression of the ulnar nerve at the Guyon's canal and, in our case, do not allow a permanent revascularisation of the ulnar artery. 1. Introduction The hypothenar hammer syndrome (HHS) is a rare clinical condition, first described by Von Rosen in 1934 [1] and named by Conn in 1970 [2], which may cause pain, a mass in the hand or finger’s ischemia. The syndrome is caused by blunt traumas to the heel of the hand that may damage the ulnar artery at the level of the hypothenar eminence, resulting in aneurysm or occlusion of the vessel [1–5]. The therapeutic approach of this syndrome is strictly correlated to its symptoms starting from a simple oral antiplatelet aggregation therapy to a surgical excision of the affected vessel and its reconstruction with a venous bypass [5–7]. We report a case in which the posttraumatic chronic inflammation of the thrombosed ulnar artery caused an acute ulnar nerve compression at the Guyon’s canal. After surgery the patient became asymptomatic, but a new thrombosis occurred. 2. Case Report A 43-year-old man, manual worker, heavy smoker (1-2 packs/day), came to the emergency department with a 2-day history of an erithematous painful tumefaction of the left hypothenar eminence that in the last 12 hours became very painful particularly involving the ring and little fingers. Physical examination showed unilateral clinical manifestations involving the dominant hand. Palpable pulses of the left radial and ulnar arteries. The patient was a middle-aged man whose occupational activities required the excessive and harmful use of the hypothenar region. The patient was a bus driver, which was exposed to vibration. A traumatic chronic inflammation of ulnar artery occurred, resulting in arterial injury. The patient reported tingling sensation, parestesia, dysesthesia, pain, and reduction of the sensitivity of the ring and
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