25 yo male, Double-A
shortstop from out of town
presents to ED c/o acute
onset left wrist pain,
occurring after fouling off a
pitch, during an at bat
earlier that day.
Additionally c/o numbness
to 5th digit of left hand. Pt
throws right, bats right.
Gen: WDWN, NAD
MSK: Left hand shows
pain 2/2 axial loading to
4th and 5th
TTP over hypothenar
eminance, sensation to
5th digit and lateral aspect
of 4th, and decreased grip
strength. ROM to wrist
and hand is nml.
1. Hand xray appears nml – AP view frequently is nondiagnostic with Hamate
fractures (esp hook fx). Diffinitively dx with carpal tunnel view radiograph
if suspicion is high.
2. CT will most easily demonstrate fracture, but not necessary for diagnosis
Treatment is similar to most other carpal fractures:
1. Pain control
2. Splint immobilization with short arm, volar splint
3. Orthopedic referral in 1-2 weeks.
Hook fractures can cause ulnar nerve injury or progress to
non-union, both will need outpatient hook excision.
Hook fx more common than body
Associated with swinging injuries
Baseball bat, golf club, racquet
Due to vibration or direct blow to hamate
Hook form border of Guyon’s Canal, housing Ulnar artery and
Dx usually confirmed by point TTP over hook – 1 cm distal and
radial to pisiform
Also, decreased grip strength, dorsal wrist pain, ulnar paresthesias
Assoc with fracture/dislocation at base of 4th or 5th MCs
Tx key is early immobilization to prevent avascular
complications, however most will need hook excision with
excellent prognosis and favorable return to baseline function
Hamate fx of body with
proximal 4th MC fx.
Normal Carpal Tunnel (reverse