The wrist is made up of the ends of the forearm bones (ulna and radius) and eight small bones called carpals. The hamate is one of the largest carpal bones and is located on the pinky side of the palm. The hamate has a protrusion called the "hook of hamate." Hook fractures can occur from a direct injury to the bone or from an indirect blow that occurs most commonly in sports.
In golf, most hook of hamate fractures occur because of the position of the golf club resting on the hook. When hitting a large divot, or hitting the mat at the range where the club head abruptly stops, the force can be displaced into the club shaft. That force is transmitted directly to the wrist and can cause a fracture of the hook of the hamate.
Diagnosis and Treatment
A fracture of the hook of the hamate can be difficult to visualize with x-rays, and a CT scan may be required to make the diagnosis. Although a few isolated cases of healing with a splint and immobilization with a cast have been reported, surgery is usually necessary. Often, the best way to treat a fracture of the hook of hamate is to remove the hook itself. Complex fractures usually do not heal with conservative treatment, and surgically removing the fractured part of the bone remains the treatment of choice in these cases.
Some surgeons prefer another procedure known as an open reduction with internal fixation (ORIF) with a screw.
Following hook of hamate removal or ORIF surgery, rehabilitation starts after the wrist is immobilized for 10 to14 days. The golfer is able to initiate wrist bending and extending when cleared by the doctor, with the main goal of achieving full range of motion. Golfers may return to their previous level of play when the incision heals enough so it is no longer tender, and they are able to play without discomfort.
What to expect following surgery
The incision site may be tender after the operation, and hand weakness may affect grip strength. It is important to initiate shoulder and elbow exercises to prevent a loss of arm strength and stability. A bicycle rider's glove can be used to pad the pinky side of the palm and reduce pain when exercising.