This patients clinical presentation is most consistent with a chronic hook of the hamate fracture, which should initially be evaluated with a carpal tunnel view radiograph. Hook of the hamate fractures typically are associated with pain localized to the hypothenar eminence, and chronic cases can be associated with neuropathy of the ulnar nerve. Excision of the hook through the fracture site usually yields satisfactory results in the presence of chronic injuries.
Parker et al treated five patients with six hook of the hamate fractures over an eight year period. All patients ultimately underwent hook resection and returned to their previous level of activity in 6 to 8 weeks after surgery without loss of function. Based on their case series, they concluded that the entire hook should be resected to the base of the hamate as the primary form of treatment in hook of the hamate fractures.
Illustration A: Patient positioning for carpal tunnel radiograph-wrist is extended 70 degrees, and beam is angled 25-30 deg to the long axis of the hand(arrow).
Illustration B: Carpal tunnel view radiograph demonstrates a fracture at the base of the hook of the hamate(black arrow) and normal pisotriquetral joint space.
1-Bone scans are not typically indicated in the diganostic setting of acute or chronic hook of the hamate fractures.
2-Imaging should be obtained to rule out bony injury prior to obtaining an EMG study.
4-CT scans can used to confirm the diagnosis of a hook of the hamate fracture after obtaining a carpal tunnel view radiograph.
5-Contrast enhanged MRA of the wrist is typically used to diagnose hypothenar hammer syndrome or other vascular abnormalities.
Parker RD, Berkowitz MS, Brahms MA, Bohl WR. Hook of the hamate fractures in
PMID:3799882 (Link to Abstract)
Garrick JG (ed): Orthopaedic Knowledge Update: Sports Medicine 3. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2004, pp 113-128