2.  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.
 AFVSS
 Gen: WDWN, NAD
 MSK: Left hand shows
pain 2/2 axial loading to
4th and 5th
metacarpals, moderate
TTP over hypothenar
eminance,  sensation to
5th digit and lateral aspect
of 4th, and decreased grip
strength. ROM to wrist
and hand is nml.

3. Xray hand
CT wrist

4. H
Carpal tunnel
hook
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
(100% sensitive-Rosen’s***).

5.  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.

6.  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
nerve
 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

7. Hamate fx of body with
associated intra-articular,
proximal 4th MC fx.
Normal Carpal Tunnel (reverse
oblique) view.

8.  http://www.biomedsearch.com/nih/Case-report



right-hamate-hook/17038179.html
Marx: Rosen’s Emergency Medicine, 7th ed. Ch 48:
Wrist and Forearm
http://www.springerimages.com/Images/RSS/110.1007_s00256-009-0842-3-0
Tintinalli’s Emergency Medicine: A Comprehensive
Study Guide, 7th ed. Chapter 226: Wrist Injuries
http://www.wheelessonline.com/ortho/hamate