Management of ulnar artery thrombosis is a complex problem. Diagnosis is confirmed by Allen testing; other special studies are needed for adequate evaluation of circulation, and arteriography is necessary before definitive therapy can be planned. Treatment must be patient oriented and directed at the underlying abnormality. Options for treatment include arterial reconstruction using reversed interposition vein grafting, mechanical sympathectomy performed by surgical resection of the thrombosed segment and ligation of the artery, and nonsurgical treatment.