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Hand–arm vibration syndrome (HAVS) includes a spectrum of vascular, neurological and musculoskeletal symptoms resulting from exposure to vibrating tools. Hypothenar hammer syndrome (HHS) is a lesion of the ulnar artery as it courses adjacent to the hamate bone and results from either single or repeated episodes of trauma to the hypothenar eminence. There is a need to distinguish symptoms of HHS from those of classical HAVS since precise diagnosis may alter both the clinical and occupational management of the affected employee.To highlight the value of simple Doppler assessments of the palmar blood flow to distinguish the condition of HHS from ‘classical’ HAVS.Among patients assessed for HAVS by the authors during 2006, three were identified as potentially having HHS. Doppler ultrasound of the palmar arches with and without ulnar arterial occlusion was used.We report three cases in which Doppler ultrasound assessment supports a diagnosis of HHS.It is our recommendation that such Doppler assessments should form part of the clinical assessment of workers being assessed in connection with exposure to hand-transmitted vibration and in whom symptoms are present that are not typical of ‘classical HAVS’, particularly where there is a history of possible hypothenar trauma.