Hook Of Hamate Research Articles

Surgical Treatment of Fracture of the Hamate Hook in Baseball Players

Surgical Treatment of Fracture of the Hamate Hook in Baseball Players

Position Change of the Neurovascular Structures around the Carpal Tunnel with Dynamic Wrist Motion

The purpose of this study was to determine the anatomic relationships between neurovascular structures and the transverse carpal ligament so as to avoid complications during endoscopic carpal tunnel surgery. Twenty-eight patients (age range, 35-69 years) with carpal tunnel syndrome were entered into the study. We examined through wrist magnetic resonance imaging in three different positions (neutral, radial flexion, and ulnar flexion) and determined several anatomic landmark (distance from the hamate hook to the median nerve, ulnar nerve, and ulnar vessel) based on the lateral margin of the hook of the hamate. The median nerve and ulnar neurovascular structure were studied with the wrist in the neutral, ulnar, and radial flexion positions. The ulnar neurovascular structures usually passed just over or ulnar to the hook of the hamate. However, in 12 hands, a looped ulnar artery coursed 0.6-3.3 mm radial to the hook of the hamate and continued to the superficial palmar arch. The looped ulnar artery migrates on the ulnar side of Guyon's canal (-5.2-1.8 mm radial to the hook of the hamate) with the wrist in radial flexion. During ulnar flexion of the wrist, the ulnar artery shifts more radially beyond the hook of the hamate (-2.5-5.7 mm). It is appropriate to transect the ligament greater than 4 mm apart from the lateral margin of the hook of the hamate without placing the edge of the scalpel toward the ulnar side. We would also recommend not transecting the transverse carpal ligament in the ulnar flexed wrist position to protect the ulnar neurovascular structure.

Lesão aguda do ramo motor do nervo ulnar no punho após treinamento com cabo de guerra

Artigos que correlacionam achados clinicos e eletrofisiologicos da lesao do nervo ulnar no punho sao incomuns na literatura, se comparados com lesoes no cotovelo. Apresentamos o caso de um paciente com atrofia da musculatura intrinseca da mao, secundaria a lesao exclusiva do ramo motor do nervo ulnar, localizada no canal de Guyon, proxima ao gancho do hamato. Revisamos aspectos anatomicos, clinicos, neurofisiologicos da lesao do nervo ulnar, de localizacao distal e enfatizamos a importância da abordagem multidisciplinar. Especificamente relacionado ao mecanismo de lesao do paciente (cabo de guerra), nao encontramos casos semelhantes na literatura e alertamos quanto aos riscos durante o treinamento fisico militar.

Rupture of Small Finger Flexor Tendons Secondary to Asymptomatic Nonunion of the Hamate Hook

The incidence of fractures of the hamate hook (hamulus) has been reported to be between 2% and 4% of all carpal fractures. Untreated hamulus nonunion can cause attritional rupture of the ulnar digits' flexor digitorum profundum tendons. Rupture of flexor tendons due to nonunion of the hook of the hamate is an uncommon injury. Most surgeons treat the tendon lesion by a graft, transfer of the superficial flexor of the ring finger, or terminolateral suture of the distal stump of the deep flexor tendon of the little finger to the deep flexor tendon of the ring finger. This article reports a case of a 52-year-old right-handed man who presented with weakness of grip and loss of active flexion of both distal and proximal interphalangeal joints of the right small finger lasting 2 weeks due to grip strength while working. The clinical history and the physical examination were dissonant, and a computed tomography scan revealed a nonunion of the hamulus. Intraoperatively, the nonunion of the hamate hook was identified and the bony ossicle excised. The flexor digitorum profundus and superficialis to the small finger were both ruptured. The flexor digitorum profundus tendon was repaired with a termino-terminal suture. The patient returned to work within 3 months without restriction. Six months postoperatively, the patient had no pain and achieved full active flexion of the small finger.

Clinical classification and treatment strategy of hamate hook fracture

To explore the clinical classification of hamate hook fracture and the treatment strategy for different type of fractures, 12 patients who suffered from hamate hook fractures were followed up retrospectively. According to the fracture sites and the prognosis, we classified the hamate hook fractures into 3 types. Type I referred to an avulsion fracture at the tip of hamate hook, type II was a fracture in the middle part of hamate hook, and type III represented a fracture at the base of hamate hook. By the classification, in our series, only 1 fell into type I, 7 type II, and 4 type III. The results were evaluated with respect to the functional recovery, recovery time and the association among the clinical classification, pre-operative complications and treatment results. The average follow-up time of this group was 8.4±3.9 months. Two cases were found to have fracture non-union and both of them were type II fractures. Six patients had complications before operation. Five cases were type II fractures and 1 case type III fracture. All the patients were satisfied with the results at the time of the last follow-up. Their pain scale and grip strength improved significantly after treatment. All the pre-operative complications were relieved. The recovery time of hamate hook excision was significantly shorter than that of the other two treatments. The incidences of both pre-operative complications and non-union in type II fractures were higher than those in type I and type III fractures. It was concluded that, generally, the treatment effects with hamate hook fracture are quite good. The complication incidence and prognosis of the fracture are closely related to the clinical classification. Early intervention is critical for type II fractures.

Hook of Hamate Pull Test

Hook of hamate fractures are often missed despite a distinct history. The purpose of this report was to describe a specific physical examination test that is diagnostic for a hook of hamate fracture, the hook of hamate pull test. It is highly sensitive and was positive in a consecutive series of 5 patients treated for a hook of hamate fracture. These patients also had a distinctive history of playing racket- or club-type sports and presented with longstanding wrist or palm pain.

The Early Use of Static and Dynamic Orthoses in Postoperative Release of Elbow Heterotopic Calcification. Case Report.

surement of in vivo cross-sections of the carpal tunnel by MRI, when changed by applying HET. Methods: Eight participants [8 women, median 47 years (43–52)] without history of wrist disorders were studied. Kinematic MRI of the right wrist was performed with a 0.2-T horizontally open unit, and the carpal tunnel measurement was assessed by the method of Mesgarzadeh. Two conditions were applied for each position. The first imagewas taken of thewrist pre-HET, and for the second image, HET was applied. The cross-sectional images calculated the distance, named TH, between the trapezium and hamate hook, and the perpendicular distance, named PD, lowered from the top of the transversal carpal ligament in TH. TheBowingRatio (BR)was calculated with PD/TH.A series of paired t-tests were used to determine the influence of HET. Significance was attributed to P values less than 0.05. Results: Pre-HET, the mean values of TH, PD, and BR were 21.03 mm, 2.02 mm, 0.096 mm, respectively. In HET, the mean values of TH, PD, and BR altered to 22.1 mm, 1.51 mm, and 0.068 mm, respectively. The data analysis of the pre-HET and HET tests showed significant differences in TH, PD, and BR. Conclusions: The HET applied to the carpal tunnel causes significant change in the dimension of the carpal tunnel. Relevance: The results of this study demonstrate that the HETwas caused a significant increase in TH and decrease in PD and BR. Sucher reported that the transversal carpal ligament (TCL) expanded from 0.9 to 2.9 mm. In the present study, there was admittedly a significant increase in TH and decease in PD and BR by HET. Therefore, it is suggested that the TCL expanded. Moreover, Berquist described that the BR of CTS patients was about 1.5 and those of healthy subjectswere about 0.7. It is suggested that the HET helps the carpal tunnel to function more normally.

Effect of finger position on the median nerve area within the carpal tunnel: an ultrasound imaging study

Introduction Finger flexion has been suggested to contribute to the aetiology of carpal tunnel syndrome (CTS). The purpose of this study was to measure the immediate effects of finger flexion on the cross-section area of the median nerve (MNA). Methods Thirty-one healthy volunteers participated in this experimental study. The MNA was measured at the level of hook of hamate using high-resolution ultrasonography during four different finger positions. Results A significant change in MNA during different finger positions was found ( F = 24.149, P < 0.001). The biggest difference in MNA was recorded between full finger extension and forceful finger flexion (mean difference = 1.29 mm2, P < 0.001). An inverse correlation between MNA and finger flexion was found (Pearson's r = −0.348, P = 0.002) where the MNA decreased as fingers moved toward flexion. Conclusion Finger flexion resulted in direct decrease in MNA, possibly contributing to median nerve compression. Clinical implications Hand therapists need to consider modifying their conservative treatment of CTS by limiting activities that require finger flexion and restricting the movement of the wrist and fingers to restrict finger flexion, thus limiting pressure increase on the median nerve.

Simplified dorsal approach to fracture of the hamate hook with percutaneous fixation with screws

We present a new method for treating a fracture of the hook of the hamate with a percutaneous screw using a dorsal approach. Through this small incision, the fracture may be fixed easily and safely while avoiding damage to the blood supply of the hamate and the surrounding soft tissue.

Dynamics of Intracarpal Tunnel Pressure in Patients With Carpal Tunnel Syndrome

To measure pressure within the carpal tunnel (intracarpal tunnel pressures) in patients with carpal tunnel syndrome and determine the effect of quantified active hand use on both the magnitude and location of peak pressures, before and after division of the transverse carpal ligament. We measured intracarpal tunnel pressures intraoperatively in 12 patients with carpal tunnel syndrome at 5 standardized locations based on the distance between each patient's proximal pisiform and hook of hamate (HH) before endoscopic division of the ligament, using a semiconductor gauge pressure sensor inserted from proximal to distal into the tunnel under fluoroscopic control. At each location, pressure was recorded with fingers extended, fingers flexed, and 50% maximum grip using a grip dynamometer. Additional hand use activities, including maximum key and pulp pinch using a pinch dynamometer, 25% maximum grip, and maximum grip, were performed by a subset of these patients. After ligament division, we measured pressures during the same hand activities at a single location, HH. We analyzed the effect of hand activity, measurement location, and ligament division using repeated measures analysis of variance. Compared with fingers extended (mean pressure, 56 mm Hg), all pinch and grip activities caused significant increases in pressure at HH, with a mean peak pressure of 1151 mm Hg during maximum grip. After endoscopic release, pressures decreased significantly at HH for all hand activities. In patients with carpal tunnel syndrome, intracarpal tunnel pressures during active hand use are substantially greater than previously reported. Peak pressures occur at the HH, where the tunnel is most constricted and the median nerve is most compressed in carpal tunnel syndrome. Therapeutic IV.

Minimal Invasive Fixation of Hamate Hook Fractures Through a Dorsal Percutaneous Approach Using a Mini Compression Screw: An Experimental Feasibility Study.

Isolated fractures of the hamate hook can be treated by conservative or surgical means. Because nonoperative treatment is associated with high nonunion rates, surgical treatment with open reduction and internal fixation through a palmar approach is often preferred. The aim of this study was to refine surgical treatment of hamate hook fractures using a cannulated mini compression screw through a dorsal percutaneous approach. Artificial fractures of the hamate hook were created in five male cadaver hands under fluoroscopy. Using an ulnar approach, the hamate hook was fractured at the base (n = 3) and middle third (n = 2) of the hook using an osteotome. Each fracture was visualized by X-ray and computed tomography. Under fluoroscopy, the fracture was stabilized with a 1.1 mm K wire through a dorsal percutaneous approach which guided the introduction of a 3 mm diameter cannulated mini compression screw. The screw position was then controlled by X-ray and computed tomography. Percutaneous fixation of the fractured hook through the dorsal approach was achieved in all cases. Regardless of the fracture location, all fragments were adapted into anatomically correct positions. No displacement or disruption of the cortex of the hook was observed with central screw positioning. Minimal invasive repair of isolated hamate hook fractures through a dorsal percutaneous approach is feasible. The special properties of the cannulated mini compression screw allow optimal screw positioning and stable fixation without risk of diplacement or disruption of the hook fragment.

Carpal Tunnel Volume Changes of the Wrist Under Distraction

This study attempts to determine changes in carpal canal volume with distraction across the wrist. Uniform longitudinal distraction was maintained with two external fixators on the radial and ulnar aspects of the forearm axis of five cadaver specimens. After CT scanning, volume determinations were made at 5 mm increments beginning at the lunocapitate joint to a point 1.5 cm distal to the middle finger carpometacarpal joint. There was a statistically significant decrease of the mean total carpal canal volume from 0 to 4.54 kg of distraction, with no statistically significant decrease from 0 to 2.27 kg or 2.27 to 4.54 kg. The largest decrease occurred at 15 and 20 mm distal to the proximal edge of the transverse carpal ligament corresponding to the level of the hamate hook. Reduction in mean carpal canal volume was 10.2% and 7.5% at these distances, respectively, from 0 to 4.54 kg of distraction. Progressive distraction across the wrist causes a decrease in total carpal canal volume.

Anatomic Localization of Motor Points for the Neuromuscular Blockade of Hand Intrinsic Muscles Involved in Thumb-in-Palm

To determine the location of the motor points and intramuscular branches for the muscles involved in thumb-in-palm and the abductor pollicis brevis muscle, the latter of which, because of its anatomic proximity, may be inadvertently blocked. Hand intrinsic muscles from 20 fresh cadavers were dissected. The point of nerve entry to the muscle belly and the points where the intramuscular endings were located most proximally and distally were defined in relation to a reference line connecting the hook of hamate and the head of the first metacarpal bone. We were able to define a region, located from 66.08% +/- 8.67% to 70.28% +/- 10.62% of the reference line, with the hook of hamate as starting point, where intramuscular endings for the thumb-in-palm muscles were dense and farther from the intramuscular endings for the abductor pollicis brevis. The region around 40% of the reference line was the point where the intramuscular endings were most dense for the abductor pollicis brevis. The results may provide guidelines that could help in localizing the appropriate points for the neuromuscular blockade of thumb-in-palm muscles and, at the same time, help in minimizing the inadvertent block of the abductor pollicis brevis.

Osteoid Osteoma of the Hamate

Uncommonly affecting the carpus, osteoid osteoma, a benign bone lesion, will involve the hand in 10% of cases. With negative initial radiographs and persistent tenderness in a 15-year-old boy after a fall, a wrist magnetic resonance imaging revealed extensive hamate edema without a fracture line. He was casted for a presumed hamate fracture. Without complaints of dysthesias or weakness, marked localized tenderness over the hamate, mild dorsal carpal edema, and limitation of wrist motion was noted 6 months later despite immobilization and rest. A computed tomography (CT) scan revealed a round, osteolytic lesion ulnarly at the hamate hook's base. Within the classic zone of sclerosis, a central calcification was visualized. Irregular periosteal bone formation is seen on the hamate hook and the dorsal aspect of the hamate. A volar curetting of the lesion was performed without grafting as stability was not threatened. Permanent sections consisted of a bony nidus with compact sclerotic, poorly organized osteoid. The central tissue was vascular with many osteoblasts, fibroblasts and mesenchymal cells. Following surgery, his pain remitted completely. Characteristics of pain and swelling have been consistent among reported cases of osteoid osteoma. Presentation may include warmth, erythema and restriction of motion. A delay in diagnosis is present in all cases involving the hamate usually due to negative plain radiographic findings. Magnetic resonance imaging findings further delayed diagnosis and treatment. Lesions are more accurately and frequently diagnosed in children with the use of CT.

Fragment Excision for the Treatment of Hamate Hook Nonunion

Purpose: To evaluate the treatment results of fragment excision of the hamate hook nonunion. Materials and Methods: Nine patients operated for hamate hook nonunion were reviewed retrospectively, and were clinically assessed for pain, range of motion, tingling sensation, and grip strength postoperatively. Results: The initial symptoms were pain (3 cases), tingling sensation (3 cases), 5th DIP joint flexion LOM (2 cases), and pain and accompanying LOM in 5th DIP joint flexion (1 case). The causes of injuries seemed to be mainly associated with sports activities. Time from initial symptom to diagnosis was averaged 15 months (2 months-5 years), and confirmative image was plain x-ray (one case), carpal tunnel view (six cases), and CT scan (two cases). All patients underwent fragment excision, and in three patients with accompanying carpal tunnel syndrome, transverse carpal ligament release was performed accordingly. In three other patients complicated with 5th FDP rupture, tenorrhaphy was performed in two cases, and tendon transfer was performed in the other case. Eight patients showed excellent clinical results one year postoperatively, but one patient complained of transient tingling sensation on the 4th and 5th fingers. Conclusion: Hamate hook excision after nonunion showed excellent clinical results in one year postoperative follow-up.

Ulnar nerve palsy after open carpal tunnel decompression: Case report and review of the literature

ABSTRACTopen carpal tunnel release is the commonest surgical treatment of median nerve compression at the wrist. although successful in most cases, there are well described complications. we report a case of laceration of the deep motor branch of the ulnar nerve at the level of the hook of hamate following a complicated carpal tunnel decompression. good surgical technique and knowledge of wrist anatomy are essential for performing this apparently simple procedure safely.

Ulnar nerve palsy after open carpal tunnel decompression: Case report and review of the literature

Open carpal tunnel release is the commonest surgical treatment of median nerve compression at the wrist. Although successful in most cases, there are well described complications. We report a case of laceration of the deep motor branch of the ulnar nerve at the level of the hook of hamate following a complicated carpal tunnel decompression. Good surgical technique and knowledge of wrist anatomy are essential for performing this apparently simple procedure safely.

A small invasive operation with dorsal approach for old hamate hook fracture

A small invasive operation with dorsal approach for old hamate hook fracture

A persistently painful hand

The CT scan shows non-union of a fracture through the tip of the hook of the hamate, previously missed by the radiologist on plain radiographs. Fractures of the hook of...

A Case of Hypothenar Hammer Syndrome Presented as Digital Ulcerations

Hypothenar hammer syndrome (HHS) is a non-atherosclerotic, non-inflammatory vascular disease that causes a digital ischemia as a result of the occlusion of distal ulnar artery adjacent to the hook of hamate. This syndrome is usually observed in men who use the hypothenar eminence of the hand to grip devices such as a hammer. As a consequence of repeated blunt trauma, the ulnar artery beneath hypothenar eminence may lead to pathologic changes, such as intima-medial hyperplasia and reactive inflammatory infiltrates, which lead to the digital ischemia. We experienced a case of HHS with digital ulcerations which occurred after intensive work with nail remover for 10 days. Selective angiography of right forearm showed complete occlusion of the ulnar artery at the level of hook of hamate with deficient superficial palmar arch. After treatment with intravenous prostaglandin E1 and heparin, the ulcerative lesions of fingers improved without surgical intervention, which implicates that medical management of HHS should be considered prior to the surgical treatment.