Signs and Symptoms
- Pain and swelling in the palm in the region just beyond the wrist crease in line with the ring and little fingers
- Discomfort with direct pressure over the above noted area in the palm
Diagnosis
- History and physical exam
- Special view x-rays can show the fracture
Background
The wrist is made up of 8 small, marble-sized bones, or “carpals,” that form the wrist. These bones are right in between your long forearm bones and your hand metacarpal bones. The hamate is one of these 8 wrist bones. It has a small projection coming off of it called the “hook of the hamate,” which is most often fractured by people that play baseball, golf, and racquet sports.
Hamate hook fractures can be treated conservatively through splinting or immobilization, but surgery is often required. Because of the bone’s proximity to the ulnar nerve, the broken bone fragment can easily become displaced and create numbness or tingling to the small and ring fingers. If such nerve impingement is allowed to occur, permanent numbness and hand muscle atrophy can occur over time. Issues can also occur because of the hamate hook’s relatively poor blood supply, which can lengthen recovery in a best-case situation, and prevent healing altogether in a worst-case situation, if it is allowed to heal on its own.
Surgery typically entails removing the bone fragment and smoothing out the surface of the remaining hamate bone. Any tendon or nerve damage that has resulted may be addressed as well.
Treatment
Conservative (Non-Surgical)
For new non displaced fractures
- Immobilization with a splint or cast
Surgery
For displaced and non healing fractures
Hand Therapy
Week 1-2:
- 1 week after surgery, the bulky dressing will be removed. Compressive gloves, fingersocks, or dressings may be applied for swelling management. Stitches will be removed 10-14 days after surgery.
- A custom splint may be made for you to immobilize the fingers/wrist. This will position your hand to minimize any stress or movement. It is important to carefully follow instructions for splint wear, in order for proper healing to occur.
- Keep your hand elevated about the level of your heart when possible to minimize swelling.
Week 2-3:
- Therapy will be initiated in this time frame. Your therapist will take initial measurements, and give you some basic range of motion exercises to begin addressing any stiffness. Moving your hand will also help with swelling as well. Complete your exercises daily, and continue wearing the splint between exercise sessions.
- Your therapist will use hot packs, massage, and other techniques to improve hand/finger stiffness and pain, and to prevent excessive scar formation.
- Despite the fact that you are now allowed to move your hand/fingers during exercises, it is important that you continue to avoid any strenuous or resistive activities. Using hand grippers or stress balls at this point will put undue strain on the healing hand, and will cause painful inflammation.
Week 4-6:
- By this point, pain and swelling should be decreasing steadily. Your active motion home exercises may be upgraded as tolerated.
- Stiffness may still be lingering, so gentle stretches will be started at this time to maximize range of motion.
- Continue wearing the splint between exercises. Avoid all activities involving grasping, pinching, squeezing, pushing, or pulling.
- Therapeutic ultrasound may be used to expedite bone healing.
Week 7-8:
- Active movement and stretching will continue, and light hand strengthening will begin at this time. This may include various hand exercisers, resistance bands, and progressive resistive movement. Your home program may be updated to reflect these changes.
- Splint wear will be gradually decreased, although you may be instructed to wear it for certain activities.
Week 9-10:
- Depending on your progress, you can typically return to most activities by this time. Heavy grabbing, squeezing, pinching, pulling, or pushing should be avoided for several more weeks.
- If you are returning to sports, your therapist or physician may instruct you to continue wearing a special splint for sports only.
