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Hook of Hamate Tenderness

Exams and Signs

Historical Overview

  • The term hamate derives from the Latin word “hamatus,” meaning hooked.

Description

  • Patients experience hook of hamate tenderness radial and distal to the pisiform in the hypothenar eminence.1
  • If the hand examination is delayed, the tenderness may decrease, making the physical and radiographic diagnosis more difficult.2

Pathophysiology

  • Hook of hamate tenderness is often caused by a hook of hamate fracture of the nondominant hand. This fracture may be related to a direct blow, often occurring while playing hockey, golf or baseball. It can be caused by compressive forces, shear forces or a combination of both.3
  • In rare cases, hook of hamate tenderness may be caused by spontaneous flexor tendon rupture in a patient with systemic lupus erythematosus (SLE). In these cases, nonunion of the hook of hamate can result in mechanical attrition of the tendons.4

Instructions

  1. Record the patient’s history, including any sports-related injuries. Ask the patient to rate how much pain s/he usually experiences in the affected wrist on a scale from 1 to 10.
  2. To check for fracture, palpate the hook of hamate radial and distal to the pisiform in the hypothenar eminence.1
  3. Observe tenderness, swelling and/or pain over the hook of hamate.
  4. Examine the contralateral wrist for comparison.

Variations

  • Determine whether the patient has ulnar nerve symptoms; the ulnar nerve is closely related to the hook of hamate.1

Related Signs and Tests

  • Hook of hamate pull test (HHPT)
  • Tinel’s test in Guyon’s canal
  • Grip strength
  • Neurovascular exam
  • Computed tomographic (CT) scan
  • Radiography

Diagnostic Performance Characteristics

  • To verify the diagnosis of a hook of hamate fracture, utilize a narrow-cut CT scan.2
  • Do not use other patients’ reactions as a comparison, because other patients may have different perceptions of similar tenderness and/or pain.

Additional Information

Presentation Photos and Related Diagrams
Hook of Hamate Palpation
  • Palpation for tenderness at the hook of the hamate (arrow at pisiform)
    Palpation for tenderness at the hook of the hamate (arrow at pisiform)
Definition of Positive Result
  • A positive result occurs when there is increased tenderness at the hook of hamate with pressure.
Definition of Negative Result
  • A negative result occurs when pressure does not cause increased tenderness at the hook of hamate. 
Comments and Pearls
  • If non-operative treatments are ineffective, surgical excision is considered a safe technique to facilitate return to sports for high-level, amateur athletes.3
  • In hook of hamate excision, nerve injury may occur in rare cases.3 
Diagnoses Associated with Exams and Signs
Videos
Examining the hook of hamate for tenderness
References
  1. Culp R, Jacoby S. Musculoskeletal Examination of the Elbow, Wrist and Hand: Making the Complex Simple. New Jersey: SLACK Incorporated, 2012.
  2. Wright TW, Moser MW, Sahajpal DT. Hook of Hamate Pull Test. J Hand Surg 2010;35A:1887-9. PMID: 20961698
  3. Devers BN, Douglas KC, Naik RD et al. Outcomes of hook of hamate fracture excision in high-level amateur athletes. J Hand Surg Am 2013;38(1):72-6. PMID: 23200952
  4. Hosokawa T, Oda R, Toyama S et al. Spontaneous flexor tendon rupture due to an insufficiency fracture of the hamate hook in a patient with systemic lupus erythematosus: A case report. Int J Surg Case Rep 2016;27:63-5. PMID: 27552031
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