PMC6586103_01
Patient one month post mass resection. The patient is playing a live recording for his band's next studio album.
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F4a
Magnetic resonance imaging (MRI) was ordered, which showed only local soft tissue reaction, likely consistent with scar tissue or local thickening (Fig 1).
Magnetic resonance imaging of the left thumb. STIR images showing hypointensity of the ulnar digital vessel (black arrow). Note the hyperintense signal of the patent radial digital artery (red arrow). This finding was not considered diagnostic of arterial occlusion.
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F1
Surgical exploration revealed a thrombosed corkscrew ulnar digital artery (Fig 2) similar to vessel appearance in hypothenar hammer syndrome (HHS).
In situ thrombosed ulnar digital artery of the left thumb. Notice the purple discoloration of thrombus as well as the proximal white discoloration and the "corkscrew" conformation of the vessel (A, red). Thrombus was noted in the vessel when it was cut proximally, but there was no backflow even after thrombus removal. The nerve is linear and appears normal (N, black).
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F2
The segment that was resected was sent for permanent pathology in formalin (Fig 3).
Transected arterial specimen. Note that the corkscrew conformation persisted after transection, suggesting significant intimal damage.
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F3
The first, called match grip, places the fulcrum at the distal phalanx of the thumb and the proximal interphalangeal joint (PIP) or middle phalanx of the index finger (Fig 4a). The traditional grip, for a right-handed player, holds the stick with the left-hand stick butt to the dorsum. It is then directed through the first web space (Fig 4b).