Hook of Hamate Fractures - Don't Miss This Tricky Diagnosis!

Author

Jesse Dashe MD
September 25, 2023

Greetings colleagues,

Welcome to the Hands-On The East Bay Newsletter, which summarizes key topics in hand surgery for providers on the front lines. I'm Dr. Jesse Dashe, an orthopedic hand surgeon at the East Bay Hand Medical Center.

Question:

Were is the hook of hamate?

Answer: 

It's a bony prominence on the ulnar side of the wrist, in the area on the photo below.

Location of hook of hamate. Source: Journal of Hand Surgery

Question:

What symptoms should raise suspicion?

Answer: 

These are often missed injuries or diagnosed late, given the vague symptoms. Symptoms include:

  • Pain with gripping with volar ulnar-sided wrist

  • Very focal tenderness to palpation over hook of hamate

  • Potential paresthesia in ulnar nerve distribution (small finger)

Mechanism of fracture. Source: Orthobullets

Question:

How are they diagnosed?

Answer: 

Hook of hamate fractures can be tricky to see on plain x-rays and require special views. These are usually diagnosed on CT or MRI.

Xray Special View: Carpal Tunnel View. Source: Orthobullets

Question:

Why intervene early?

Answer: 

Delayed treatment risks nonunion and avascular necrosis of the fragment. If this is caught early, it can be treated with casting only.

Surgery usually involves fragment excision.

Excised Hook of Hamate. Source: Journal of Hand Surgery

Question:

How are they treated by urgent cares/ED/PCPs?

Answer: 

Place in a volar resting splint or a removable wrist brace to be worn at all times and refer to a hand surgeon.

Lateral Wrist Xray. Source: Orthobullets

Please feel free to reach out if you have any questions or would like to refer any patients. You can refer patients at handreferral.com or by using this link:

If you need to reach me directly, please respond to this email or email me at [email protected].

Please contact me so I can come by your facility to meet face-to-face and/or give presentations, splinting sessions, etc.

Lastly, let me know if you have any other hand topics you would like covered in the future!

Sincerely,