How does the patient present with a Hook of Hamate fracture?
The most common history is of hitting the ground during a golf shot, with the handle of the club being forced into the palm of the left hand for a right handed golfer during the resulting jolt. The patient presents with acute pain in the hyper-thenar eminence, and usually tingling into the 4th and 5th digit as a result of injury to the distal end of the ulna nerve that wraps around the hook of hamate.
What is the treatment?
The wrist is usually put in a plaster for 6 weeks followed by a thermoplastic splint of there is delayed union. Often, however, the displaced hook has to be surgically removed to take pressure off the ulna nerve.
What exercises are required following plaster removal?
Following any immobilisation of the hand and wrist, there is usually loss of supination and pronation strength and range, as well as loss of intrinsic muscle strength and control. Specific physiotherapy exercises are required to address this, and the entire upper limb may also need retraining to ensure good proximal stability returns to the upper limb complex, particularly if returning to sporting activities.