Hook of Hamate Fracture in Athletes Can Be Complex
Injury: Hook of Hamate Fracture
Mechanism OF INJURY
Typically occurs with a blunt trauma to the hand, usually from swinging a baseball bat, tennis racquet or golf club. The injury can also occur from a fall on to an outstretched hand. Interestingly, in baseball players the injury can develop over time as a stress fracture from repetitive motions.
Most individuals will have pain over the hook of the hamate which is in line with the pinky on the palm side of the hand (see below). Other symptoms may include decreased grip strength as well as pain holding a baseball bat or golf club. An evaluation should be be done to assess the nerves and the blood flow to the wrist. The patient can be asked to give a thumbs up, make an "Ok" sign, and spread their fingers against resistance to grossly assess nerve function. Also the pulse should be checked as well as finger tips monitored to check for good blood flow to the area. An x-ray is usually done first, but the fracture can be difficult to spot. The optimal test to confirm the diagnosis is a CT scan of the hand.
Although it can occur in children, these fractures tend to occur most often in adults. Non-operative treatment typically consists of a short arm cast (below the elbow) or a hand based splint to protect the hamate bone (see below). However, nonoperative treatment has a high failure rate. Surgical treatment of a hamate fracture includes removal of the broken piece, which generally has good results. Keep in mind that due to major nerves around the area of the hamate bone complications of impaired grip strength or nerve pain may occur with surgical intervention. In some instances, high level athletes may opt to proceed with surgical treatment of the fracture as not to risk prolonged recovery due to failed nonoperative treatment. Athletes are usually able to return back to sports completely in approximately 6 to 8 weeks.
Return TO PLAY
Return to play after a hook of the hamate fracture may require protective padding or splinting until all tenderness has resolved and full range of motion has returned.
The return to sports can be expedited, if the athlete is in a sport that does not require one's hands or the athlete does not need to use the injured hand during the sport. Example would include a soccer athlete or the non-throwing hand of a baseball pitcher.
Exam technique illustrating point of tenderness with a hamate fracture
Hand based splint for hamate fracture