Introduction Hook of hamate fractures make up 2-4% of carpal bone fractures.
Hook of hamate fractures make up 2-4% of carpal bone fractures. The hamate is the most ulnar carpal bone within the distal row of carpal bones. The hook of hamate projects in a volar direction into the palm.
There are multiple attachments to the hook of hamate including the transverse carpal ligament , flexor digiti minimi, and pisohamate ligament. The hook of hamate makes up the medial border of the carpal tunnel and lateral portion of the Guyon's canal. Hook of hamate fractures occur due to compressive forces that transmit across the hamate during a forceful torque of the wrist.
These fractures are seen more commonly in tennis, golf, and baseball. Hook of hamate location in relation to a bat grip Diagnosis Patients with a hook of hamate fracture will typically complain of ulnar sided palmar pain when they grip an object. Any athlete also complaining of flexor tendonitis of the fourth and fifth digit should be evaluated for a hook of hamate fracture that is irritating the tendons during flexion.
In order to diagnosis the fracture, one clinical exam technique involves putting the wrist in ulnar deviation and then actively having the patient flex the fourth and fifth digits and evaluating for any symptoms. Rarely, a hook of hamate fracture can injure the medial or ulnar nerve, so a thorough neurovascular exam should be obtained in any patient where a fracture is being considered. When trying to palpate the hook of hamate, providers should first palpate the pisiform.
They should then roll their thumb towards the center of the palm and the first bony structure they palpate is the hook of hamate. Palpation of the hook of the hamate Hook of hamate fractures are difficult to view on standard PA, lateral, and oblique radiographs. There are signs of a hook of hamate fracture on standard radiographs including absence of the hook, sclerosis of the hook, and lack of a cortical density.
If you are experiencing symptoms that may be related to diagnosing hook of hamate fractures, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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