Massage therapy · Kitchener–WaterlooHook of Hamate Fracture

The wrist is composed of eight small bones (carpals) and the forearm bone ends (radius and ulna). The hamate is one of the carpal bones, located on the little-finger side of the palm. There is a curved protrusion on the hamate, which is known as the hook of hamate, and it sticks out towards the palm (Kim et al., 2018). A hook fracture can occur from a direct blow to the bone or from repeated impacts, and it most often happens in sports that need a strong grip, such as golf, baseball and tennis (Kim et al., 2018; Donohue, Calcaterra and Fowler, 2024).

When it comes to golf, the end of the club handle rests against the hook. Repeated knocks from the end of the club, racquet or bat are thought to cause these fractures (Kim et al., 2018). When you hit into a large divot, tree stump, or hit the mat at the range where the head of the club stops abruptly, the force can be passed up the shaft of the club into the hand and wrist.

Fortunately hook of hamate fractures are rare. They make up only about 2 to 4% of all fractures of the carpal bones (Donohue, Calcaterra and Fowler, 2024). It is also possible to fracture the body of the hamate (middle of the bone) as well as the hook.

Hook of Hamate Fracture Anatomy

The hamate is one of the carpal bones within the wrist, on the little-finger side. The hook rises from the body of the hamate and curves towards the palm. Several small muscles of the hand attach to it, and it forms one side of a tunnel (Guyon's canal) through which the ulnar nerve passes. The ulnar nerve gives feeling to the little finger and part of the ring finger and runs close to the tip of the hook (Kim et al., 2018). This is why a hook of hamate fracture can sometimes cause numbness or weakness in these fingers.

How a Hook of Hamate Fracture Is Treated

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

• Symptoms can include pain on the little-finger side of the palm and wrist and a weaker grip (Donohue, Calcaterra and Fowler, 2024).
• It is important that you use and learn the proper techniques whenever swinging or hitting a bat, club or racquet.
• Tell your doctor if you have numbness, tingling or weakness in your ring or little finger, as the ulnar nerve can be affected (Kim et al., 2018).
• If you think you have injured your wrist, you should go to the hospital to get it checked by a doctor. I can also assess your wrist and advise whether it should be checked for a fracture, and so can an osteopath.

After a hook of hamate fracture, your surgeon and hand therapist decide how long the wrist is protected and when you can start moving and gripping. I work inside those limits, and if you've had surgery, or the fracture stops you doing your normal daily activities, I need your team's okay before any hands-on treatment.

Please bring any X-ray or scan reports and notes from your medical team to your first visit. They're an important part of planning safe treatment for you.

While It's Protected

• Easing the forearm, shoulder and neck, and the other arm, which takes over
• Gentle lymphatic drainage and keeping the hand raised for swelling
• Keeping the fingers, elbow and shoulder moving, as far as your team allows

Once Your Team Allows More

1. Kim, H. et al. (2018) 'Isolated hook of hamate fracture in sports that require a strong grip: comprehensive literature review', Medicine, 97(46), e13275. doi: 10.1097/MD.0000000000013275.
2. Donohue, J.K., Calcaterra, M.J. and Fowler, J.R. (2024) 'Surgical management of hook of hamate fractures: a systematic review of outcomes', Journal of Hand Surgery Global Online, 6(2), pp. 183–187. doi: 10.1016/j.jhsg.2023.11.011.