Clinics in diagnostic imaging (156)

Abstract

The wrist is a common site of injury and the most frequently injured body part among professional golfers. A 37-year-old, right-handed male golfer presented with pain at the ulnar aspect of his left palm, which grew worse after an initial traumatic impact from the golf club handle. There was tenderness over the hypothenar eminence of the left palm. Computed tomography of the left wrist showed an undisplaced fracture through the base of the hamate hook. The golf-induced hamate hook fracture was managed conservatively, with cessation of physical activity involving the left hand and wrist for eight weeks. The patient made a full recovery. Repetitive trauma, exacerbated by improper wrist motion, leads to typical wrist injuries affecting golfers, such as ulnar impaction syndrome, de Quervain's disease, and tendinopathy affecting the flexor carpi ulnaris and extensor carpi ulnaris, all of which can be diagnosed on imaging.

Sliding Position of the Flexor Tendons Relative to the Hook of Hamate in CT Scans

“…1,2) The treatment methods include conservative treatment, excision, and osteosynthesis, with no consistent standard. 3,4) A high rate of nonunion formation after conservative treatment of fracture of the hook of the hamate has been reported, 5) and the incidence is high in fractures of the base due to insufficient blood flow to the hook of the hamate. 6,7) So, nonunion of the fracture is common and is usually treated with surgery.…”

A Scoping Review of the Epidemiology, Management, and Outcomes of Golf-Related Fractures

“…(62). Hook of hamate stress fracture is due to repeated microtrauma from overuse that typically occurs in the lead wrist of golfers, particularly when there is a tight grip of the club and repeated strikes to the hook of the hamate during the golf swing (29). It also may occur as an acute injury when the player strikes a hard surface with the club, for example, a tree root.…”

“…While some golfers may present with acute symptoms (pain and wrist edema) consistent with a hook of hamate fracture (30), the majority presented with chronic symptoms with a combination of diffuse pain, weakened grip, and ulnar nerve paresthesia, and sometimes without recall of traumatic incident (Supplementary Fig. 2, http://links.lww.com/CSMR/A149) (29,(31)(32)(33)(34). The time from onset of symptoms to diagnosis was 4 wk to 6 months (29)(30)(31)(32)(33)35).…”

“…2, http://links.lww.com/CSMR/A149) (29,(31)(32)(33)(34). The time from onset of symptoms to diagnosis was 4 wk to 6 months (29)(30)(31)(32)(33)35). The injury mechanism for the hook of the hamate fracture can be divided into acute, single traumatic event, or a chronic overuse injury.…”

Hook of the Hamate: The Spectrum of Often Missed Pathologic Findings

“…Nondisplaced fractures within 3 months of injury initially receive conservative treatment with cast immobilization [13, 14, 21, 24]. Treatment of symptomatic displaced fractures, nonunion, and nondisplaced hook fractures older than 3 months is controversial [21].…”