A small adventitial bursa may develop over the hypothenar eminence between the palmaris brevis and the overlying skin or between the hypothenar muscles and the palmar aponeurosis. It forms in response to repetitive direct compression of the hypothenar eminence from tool use, keyboard use with dorsal wrist extension, or habitual leaning on the little finger side of the palm.
Hypothenar eminence bursitis produces a soft fluctuant swelling medial to the wrist crease at the little finger base that is aggravated by direct pressure. It must be distinguished from Guyon canal ganglion cysts, ulnar artery aneurysm from hypothenar hammer syndrome, and superficial palmar branch ulnar nerve entrapment. Ultrasound differentiates a bursal collection from a vascular lesion. Treatment is conservative with protective padding, modified ergonomics, and aspiration with corticosteroid injection.
Repetitive hypothenar impact in workers and athletes damages the superficial hypothenar structures including the overlying bursa and the ulnar artery against the hamate hook, producing a combination of ulnar artery thrombosis or aneurysm with overlying soft tissue thickening and bursal reaction.
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