Hamate hook nonunion initially mistaken for ulnar nerve compression: a case report with review of literature

• Published in: Wiener Klinische Wochenschrift Vol. 129; no. 3-4; pp. 136 - 140
• Main Authors: Josipovic, Mario, Bozic, Dorotea, Bohacek, Ivan, Smoljanovic, Tomislav, Bojanic, Ivan
• Format: Journal Article
• Language: English
• Published: Vienna Springer Vienna 01.02.2017
• Subjects: Adolescent; Case Report; Diagnosis, Differential; Endocrinology; Fractures, Malunited - diagnosis; Fractures, Malunited - surgery; Fractures, Stress - diagnosis; Fractures, Stress - surgery; Gastroenterology; Hamate Bone - injuries; Hamate Bone - surgery; Humans; Internal Medicine; Male; Medicine; Medicine & Public Health; Pneumology/Respiratory System; Tennis - injuries; Ulnar Nerve Compression Syndromes - diagnosis; Ulnar Nerve Compression Syndromes - surgery; Tennis; Hamate hook excision; Hamate hook fracture; Hamate hook nonunion; Ulnar nerve compression
• ISSN: 0043-5325; 1613-7671
• DOI: 10.1007/s00508-016-1114-6

Summary Background Hamate hook (HH) stress fractures are rare, often presenting with misleading symptoms and easily overlooked/misdiagnosed. These fractures occur frequently in individuals participating in sports activities involving racquets, bats, or clubs. Symptoms are non-specific and often mimic other clinical conditions, such as ulnar nerve entrapment or ulnar vessel thrombosis. Case report A 17-year-old tennis player with no history of trauma presented with dominant hand weakness together with pain and paresthesia on the ulnar side, which exacerbated with tennis play. The patient was treated for ulnar nerve compression with activity cessation and rest for 2 months. After 6 months of persistent symptoms, the patient underwent open Guyon tunnel release, although preoperative electromyoneurography revealed no signs of nerve damage and bone scans showed a small area of increased uptake in the hypothenar region. Postoperatively, symptoms resumed and the patient reported to our department for a second opinion. Point tenderness over HH, hypothenar muscles hypotrophy, paresthesia, hand weakness and pain with ulnar deviation, and flexion of distal phalanges of the two ulnar fingers were observed. HH fracture was suspected. Computerized tomography scan revealed fractured HH and the patient underwent hook excision. One month postoperatively, the pain intensity reduced together with function and strength improvement; 2 months postoperatively, the patient was pain free and had returned to tennis. Conclusions In patients involved in racquet sports with hypothenar pain and paresthesia of the ulnar side of the hand, HH fracture should be suspected. Symptoms can mimic ulnar nerve entrapment and may lead to overlooking the correct diagnosis. Treatment of choice is fractured fragment excision.