Hook of Hamate fractures

The Hook of Hamate fracture  is very common in racquet, bat or holding holding athletes.

It comes about when the rigid handle is struck against the palm of the hand. It can also occur on falling onto an outstretched hand.

The Hamate bone is quite large and is in the centre of the wrist towards the little finger (ulna) side. A bony extension of the Hamate bone pushes up into the palm of the hand at the fleshy side at the base of the little finger just beyond the wrist crease and is called the Hook of Hamate because it is shaped like a hook.

This is a fracture that is often missed and can cause long-term aching discomfort in the palm of the hand. The picture shows the area of tenderness in a Hook of Hamate fracture.

The key features that occur when the Hook of Hamate is fractured is localised discomfort, pins and needles in the little and ring finger, and pain on flexing the little finger.

The pins and needles are related to the close proximity of the ulnar nerve which runs very close to the hook of Hamate.

The pain on flexing the little finger is related to the close proximity of the long flexor tendons to the little finger. 

Hook of Hamate fractures do not often show on plain x-rays and are only identified on MRI scan or CT scans. This picture is a CT scan showing the Hook of Hamate fracture identified with the yellow arrow.

 

The treatment of these fractures varies depending on the occupation and functional demands of the injured person. In my experience dealing with many professional sports people I often recommend surgical excision of the hook of Hamate to facilitate rapid return to play. However, in non-elite sports people I often recommend  a period of splint immobilization and then return to play. If after several months there is still discomfort and aching over the hook of Hamate I recommend surgical excision at this stage.

Surgery is very successful and is performed under general anaesthetic as a day case.  Careful surgical dissection is required to identify the hook projection and protect the nearby all that nerve and long flexor tendons to the little finger.

It has been my experience looking after professional athletes with a Hook of Hamate fractures that they return to competitive play somewhere between two and six weeks depending on their specific activities.