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HAMATE ARTHROSIS (PROXIMAL POLE)

Introduction

Arthrosis of the hamate is characterized by degenerative changes to this carpal bone in the midcarpal joint. Although the normal anatomy of the joint and pathogenesis of the condition have been well described in the literature, few recent studies have evaluated new surgical approaches to treatment.  Hamate arthrosis is more common in men and frequently related to wrist injuries and manual work.

Incidence and Related Conditions

Burgess was the first to describe two anatomical variations of the midcarpal joint. In Type I lunates,  the lunate has no separate facet articulating with the hamate.  The capitolunate joint has a smooth transition with the triquetrohamate joint, and the helicoid surface of the hamate is shallow, blending smoothly with the capitolunate.1,2  In Type II lunates,  the lunate has a medial facet which articulates with the hamate in addition to the facet articulating with the capitate.  Between the capitolunate and triquetrahamate joints, there is a ridged, transition facet on the proximal pole of the hamate distally and on the ulnar side of the lunate proximally.1 Among the wrists examined, a significantly larger percentage of Type II versus Type I  showed evidence of hamate arthrosis (69% vs 13%, p<0.01).  In the study by Harley et al, the majority of the patients had a Type II lunate. Furthermore, all patients had associated lunotriquetral ligament tears and many also had additional internal deragements of the wrist such as TFCC tears.2

In the largest series of wrists evaluated to date (~400), 58% had evidence of arthrosis, and the most common site of degeneration was the proximal pole of the hamate (28%).2 Arthrosis at the proximal hamate was associated with a lunate facet 38% of the time; only 2% of wrists that did not have a lunate facet had hamate arthrosis. Bilateral arthrosis was present in 69% of the wrists. For the hamate, bilateral arthrosis was present in 52% of cases.2

Differential Diagnosis

  • Triangular fibrocartilage (TFCC) tear
  • Lunotriquetral ligament tear
  • Ulnocarpal abutment syndrome
  • Pisotriquetral arthritis
ICD-10 Codes

  • HAMATE ARTHROSIS (PROXIMAL POLE)

    Diagnostic Guide Name

    HAMATE ARTHROSIS (PROXIMAL POLE)

    ICD 10 Diagnosis, Single Code, Left Code, Right Code and Bilateral Code

    DIAGNOSISSINGLE CODE ONLYLEFTRIGHTBILATERAL (If Available)
    HAMATE ARTHROSIS (PROXIMAL POLE) M19.032M19.031 

    ICD-10 Reference

    Reproduced from the International statistical classification of diseases and related health problems, 10th revision, Fifth edition, 2016. Geneva, World Health Organization, 2016 https://apps.who.int/iris/handle/10665/246208

Basic Science Photos and Related Diagrams
Lunate Type I and II
Basic Science Pics
  • Type I Lunate with only one facet (arrow) articulating with capitate
    Type I Lunate with only one facet (arrow) articulating with capitate
  • Type II Lunate with only two facets (A) articulating with capitate and (B) articulating with hamate.
    Type II Lunate with only two facets (A) articulating with capitate and (B) articulating with hamate.
Symptoms
Ulnar-sided wrist pain
History of work related wrist injury
Typical History

The typical patient is a late middle aged right handed male manual laborer who presents with right ulnar wrist pain.  The worker will frequently relate an old work related injury to the onset of his symptoms.  Activities that require ulnar deviation such as hammering nails aggrevates the symmptomatic wrist and increases the pain.

Positive Tests, Exams or Signs
Work-up Options
Images (X-Ray, MRI, etc.)
  • Hamate Arthrosis (HALT Syndrome) note on X-ray at arrow
    Hamate Arthrosis note on X-ray (arrow)
  • MRI showing Hamate Arthrosis (white arrow) and L-T ligament tear (gray arrow)
    MRI showing Hamate Arthrosis (white arrow) and L-T ligament tear (gray arrow)
Treatment Options
Treatment Goals
  • Control the symptoms
  • Maintain or improve wrist function
  • Return the patient to work
Conservative
  • Medications - NSAID's
  • Wrist band and/or wrist braces
  • Cortisone injections
Operative
  • Arthroscopic resection of the proximal pole of the hamate
  • Ulnar shortening osteoplasty with L-T debridement
  • Open resection of the proximal pole of the hamate
Complications
  • Persistent wrist pain and disability
  • Decreased range of motion
  • Post-operative infection
  • Post-operative dorsal ulnar sensory nerve injury
Outcomes
  • Excision of the proximal pole of the hamate generally provide successful outcomes; however, patients with secondary wrist pathology frequently have less reliable results.
Key Educational Points
  • Hamate arthrosis is almost always sssociated with lunotriquetral ligament tears.  This association is the origin of the acronym HALT (hamate arthrosis lunotriquetral ligament tear).2,6
  • Patients with pathology limited to the hamate and the L-T ligament usually have a speedy surgical recovery and early return to work.2
  • The Type II lunate is highly associated with hamate arthrosis.1,2,5
  • Biomechanical studies have shown no change in the force across the triquetrohamate joint after excision of the proximal pole of the hamate. 2
  • Ulnar shortening osteoplasty can simultaneously treat HALT and TFCC injuries.4
References

Cited References

  1. Burgess RC. Anatomic variations of the midcarpal joint.J Hand Surg Am 1990;15(1):129-31. PMID: 2299152
  2. Harley BJ, Werner FW, Boles SD, Palmer AK.Arthroscopic resection of arthrosis of the proximal hamate: a clinical and biomechanical study. J Hand Surg Am2004;29(4):661-7. PMID: 15249091
  3. Thurston AJ, Stanley JK. Hamato-lunate impingement: an uncommon cause of ulnar-sided wrist pain. Arthroscopy2000;16(5):540-4. PMID: 10882452
  4. Chun S, Palmer AK. The ulnar impaction syndrome: following-up of ulnar shortening osteotomy. J Hand Surg 1993; 18A: 46-53.
  5. Viegas SF, Wagner K, Patterson R, Peterson P. Medial (hamate) facet of the lunate. J Hand Surg Am1990;15(4):564-71. PMID: 2380518
  6. Pirolo JM, Yao J. Minimally invasive approaches to ulnar-sided wrist disorders. Hand Clin 2014;30(1):77-89. PMID: 24286746

Review

  1. Pirolo JM, Yao J. Minimally invasive approaches to ulnar-sided wrist disorders. Hand Clin 2014;30(1):77-89. PMID: 24286746

Classic Articles

  1. Burgess RC. Anatomic variations of the midcarpal joint.J Hand Surg Am 1990;15(1):129-31. PMID: 2299152
  2. Harley BJ, Werner FW, Boles SD, Palmer AK.Arthroscopic resection of arthrosis of the proximal hamate: a clinical and biomechanical study. J Hand Surg Am2004;29(4):661-7. PMID: 15249091
  3. Thurston AJ, Stanley JK. Hamato-lunate impingement: an uncommon cause of ulnar-sided wrist pain. Arthroscopy2000;16(5):540-4. PMID: 10882452
  4. Viegas SF, Wagner K, Patterson R, Peterson P. Medial (hamate) facet of the lunate. J Hand Surg Am1990;15(4):564-71. PMID: 2380518
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