UMEM Educational Pearls


21-year-old college softball player presents for evaluation of Left hand/wrist pain following batting practice.

She states her pinky is “tingly”

On exam, there is tenderness over her volar ulnar wrist.

You obtain an X-ray.

What’s the diagnosis?





Hook of the hamate fractures are often associated with sports that require a firm hand grip such as baseball, softball, tennis, golf. These sports cause repeated stress against the hamate bone from the gripped sporting equipment. A frequent mechanism is grounding a golf club or from the act of checking a baseball bat swing.

On physical exam, the most common finding is focal tenderness over the hook of the hamate.

Another test with high sensitivity is a hook of the hamate pull test

Place the patient's hand in ulnar deviation and ask patient to flex the DIP joints of the 4th and 5th digits against resistance.

Imaging: PA and lateral wrist views are frequently negative despite being the first line recommended imaging for wrist pain/trauma.

A carpal tunnel view has much better sensitivity to visualize the hook of the hamate.

Base fractures (less common than hook) may also be missed on carpal tunnel view and require advanced imaging using CT.

Place patient in ulnar gutter splint and arrange follow up with hand surgery.

Overall, this is an uncommon though frequently missed injury. Consider the above mentioned physical exam and imaging recommendations to improve diagnostic accuracy.