Wrist consists of eight carpal bones of which one is the hamate. When a break occurs in this little bone present in wrist, it is known as hamate fracture.
The eight carpal bones of the wrist are located between the bones of the forearm known as ulna and radius and the bones present in the hand. Hamate is a bone, which is located on the outside or the little finger side of the wrist and has a hook shaped structure at the end. The hook shaped part of the hamate bone which protrudes outwards may break easily due to injury. This condition is known as fracture of hook of hamate.
Stress or compression[1] could be placed on the hook of hamate bone while performing sports activities like racket sports or falling down on an outstretched hand. If the force is traumatic and beyond the tolerance power of the bone then this may result in fracture of the hook of hamate.
Causes of Fracture of Hook of Hamate
- Fracture of the hook of hamate is often caused by swinging a baseball bat, tennis racket or golf club, especially when it suddenly hits a stationary object.
- Direct blow to the wrist.
- Fracture of hook of the hamate can also be a result of forceful muscular contractions though there may be no direct trauma.
Signs and Symptoms of Fracture of Hook of Hamate[2]
- Pain in the wrist.
- Decreased grip strength.
- Pain may especially be experienced on the little finger side of the wrist.
- Feeling tenderness while touching the palm side of the wrist.
- Pain on palpation of the hook of the hamate.
- Numbness may be felt especially in the fourth and fifth fingers.
Treatment for Fracture of Hook of Hamate[3]
In cases where there is just a minor fracture or deviation of the bone from its normal alignment, it may be corrected with manipulation and reduction. Conservative care involves closed reduction under local anesthesia followed by casting or splinting of hand. Fracture may require about six to ten weeks for complete recovery, which involves a period of immobilization for about four to six weeks followed by protective splinting for about six weeks.
Surgery is needed in individuals who have deformity that is not able to be treated nonsurgically. This method is called open reduction.
Surgical procedure is done by making incision to expose fracture and then get it back into place. This in some cases requires use of pins, screws, etc.
In cases where the fracture of hook of hamate goes unnoticed for a good amount of time then it is likely that the fracture may not heal. In such cases, the best option may be to remove the bone fragment completely.
The risks of surgery are bleeding, neurovascular injury, infection etc.
Physical Therapy: PT is necessary to promote healing and normal function of wrist and hand. It may consist of:
- Joint mobilizations.
- Soft tissue massages.
- Ultrasound.
- Bracing.
- Ice/heat.
- Therapy for improving strength.
- Modification of activities.
- Slow return to activity.
Exercises for Fracture of Hook of Hamate
Stretching and strengthening exercises may need to be performed during the recovery phase to gain complete range of motion and functionality of the wrist.
Stretching Exercises for Fracture of Hook of Hamate
Flexion: To perform this exercise, the wrist is bent forward until a painless stretch is sensed. It can be done for five seconds and performed in two sets of 12 each.
Extension: To perform this exercise, the wrist is bent backward until a painless stretch is sensed. It can be done for five seconds and performed in two sets of 12 each.
Side-to-Side: The wrist is bent sideways till it is painless for about four seconds in one direction and then the other and is performed in two sets with 15 times in each set.
Wrist Extension Stretching: This can be done by having the elbow straight and placing fingers on an object with palms looking down. Then, the bodyweight is put forward and the position is held for about 20 seconds.
Wrist Flexion Stretching: It can be done by keeping elbow straight and placing fingers flat on an object with palms in the upward direction. Then the bodyweight is put forward and the position is held for about 20 seconds.
Pronation and Supination of Forearm: In this exercise, the elbow is bent at a right angle. The palm is then rotated up and it done for about 10 seconds. Now, the same thing is done in the opposite direction for 10 seconds. It should be done thrice with 10 times each without aggravating symptoms.
Strengthening Exercises for Fracture of Hook of Hamate
Wrist Flexion: In this, a can is held with palm looking upwards. Then the wrist is bent upwards. Slowly, the weight is decreased. It is done twice 15 times each. The weight can be increased with time.
Wrist Extension: In this, a can in held with palm looking downwards. Then the wrist is bent upwards. Slowly, the weight is decreased. It is done twice 15 times each. The weight can be increased with time.
Tennis Ball Squeeze: This is done by squeezing a soft spongy object like a ball as much as possible without aggravating symptoms for about 10 seconds and this should be done for about 10 times.
Resistance Band Wrist Flexion: In this exercise, a resistance is placed over fingers with palm facing upwards. The elbow is kept at side of body and is bent at a right angle with the support of the other hand. The next thing to do is to slowly curl fingers and wrist upwards adjoining the resistance so as to make the muscles of forearm tight. One can repeat as long as there is no exacerbation of symptoms.
Resistance Band Wrist Extension: In this exercise, a resistance is placed over fingers with palm facing downwards. The elbow is kept at side of body and is bent at a right angle with the support of the other hand. The next thing to do is to slowly curl fingers and wrist upwards adjoining the resistance so as to make the muscles of forearm tight. One can repeat as long as there is no exacerbation of symptoms..
Resistance Band Radial Deviation: In this exercise, a resistance is placed over fingers with thumb facing upwards. The elbow is kept at side of body and is bent at a right angle with the support of the other hand. The next thing to do is to slowly curl wrist upwards adjoining the resistance so as to make the muscles of forearm tight. One can repeat as long as there is no exacerbation of symptoms.
Investigations for Fracture of the Hook of Hamate[4]
A complete examination is carried out to confirm fracture of the hook of hamate. A neurovascular examination is also done of the hands to look for injuries to nerves and vessels. An x-ray may also be done to determine the severity.
Other Diagnostic Tests Are:
- MRI.
- CT scan.
