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

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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.

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Funding

The authors have not received grant support or research funding, and have no proprietary interest in the materials described in the article.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University Hospital Center Zagreb, University of Zagreb School of Medicine, Salata 6–7, 10000, Zagreb, Croatia

    Mario Josipovic MD, Ivan Bohacek MD, PhD, Tomislav Smoljanovic MD, PhD & Ivan Bojanic MD, PhD

  2. Department of Gastroenterology, University Hospital Centre Split, Spinciceva 11, 21000, Split, Croatia

    Dorotea Bozic MD

  3. Department of Anatomy and Clinical Anatomy, University of Zagreb School of Medicine, Salata 11, 10000, Zagreb, Croatia

    Ivan Bohacek MD, PhD

  4. The Elective Orthopaedic Centre, Epsom, Surrey, UK

    Tomislav Smoljanovic MD, PhD

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  1. Mario Josipovic MD
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  4. Tomislav Smoljanovic MD, PhD
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Correspondence to Ivan Bohacek MD, PhD.

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Conflict of interest

M. Josipovic, D. Bozic, I. Bohacek, T. Smoljanovic and I. Bojanic declare that they have no competing interests.

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. Informed consent was obtained from patient for being included in the study.

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Josipovic, M., Bozic, D., Bohacek, I. et al. Hamate hook nonunion initially mistaken for ulnar nerve compression: a case report with review of literature. Wien Klin Wochenschr 129, 136–140 (2017). https://doi.org/10.1007/s00508-016-1114-6

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  • DOI: https://doi.org/10.1007/s00508-016-1114-6

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