The wrist contains a total of three joints – this makes the wrist much more stable, similar to having only one joint. The joints also give your wrist and hand a wide range of movement. Furthermore, the wrist joints let your wrist move your hand up and down, for example, when lifting your hand to wave around.
These joints give you the ability to bend your wrist forward and backward, side to side, and rotate your entire hand. The three wrist joints are known as the radiocarpal joint, ulnocarpal joint, and distal radioulnar joint, with additional details following below:
- Radiocarpal joint – This is where the radius (the thicker forearm bone) connects the bottom row of your wrist bones, which are the scaphoid, lunate, and triquetrum bones. This joint is mainly on the thumb side of your wrist.
- Ulnocarpal joint – This is the joint between the ulna (the thinner forearm bone) and the lunate and triquetrum wrist bones. The ulnocarpal joint is located on the pinky side of your wrist.
- Distal radioulnar joint – This joint is in the wrist but does not include the wrist bones. It connects the bottom ends of the radius and ulna.
The hamate bone is one of small eight carpal bones located in our wrist. The hamate specifically is located on the ulnar side of the wrist, opposite the thumb. The hamate bone is sometimes described as triangular in shape and others describe it as more square-like. It is an unusually shaped bone with the defining characteristic of a hook which is a process that projects from the palm side of the hand toward the outside of the body.
This hook is important in that it provides the attachment site for many ligaments, tendons, and part of the flexor retinaculum that protects the carpal tunnel. A hamate fracture is a rare occurrence but can have significant consequences because of the many structures that attach to it. Associated injuries with a Hamate fracture are often injuries to the Ulnar nerve and Ulnar artery. It is commonly misdiagnosed as a wrist sprain, without further diagnostic techniques being ordered to determine if the bone has been broken.
Furthermore, a hamate fracture can be referred to as another condition called “golfer’s wrist”. Golfer’s wrist refers to a break in the small projection of the hamate bone. The hamate bone may be injured after experiencing abnormal stress or trauma resulting from golf.
Causes & Symptoms of a Hamate Fracture
Certain causes associated with a hamate fracture include sports involving clubs, bats, or racquets which provide the most consistent cause of hamate bone injuries due to the way in which they encourage the hand to turn and twist at speed.
It is thought that the most common of these injuries arise as a result of repeated golfing swings, accounting for one-third of all hamate injuries. Repetitive motions similar to this in any sport (hockey or tennis) may also result in a stress fracture over time.
Another prominent cause is blunt trauma to the hamate bone, resulting from direct force to the area either from another participant, or from a base of a club, bat, or racquet that is held on the hamate at the forceful moment of the swing.
Falling injuries can indirectly cause a hamate fracture through the surrounding muscles or ligaments, especially when hyperextending the wrist by landing flat on the palm. Some other wrist complaints can also lead to the condition.
Symptoms that are linked to hamate fractures include:
- Pain – Aching or sharper pain around the area of the hamate bone, which may be worsened with wrist or hand movements, especially strenuous motions involved in most bat and racquet sports.
- Limited movement – Moving the ring finger and the little finger often proves particularly painful due to their proximity to and connection with the hamate bone.
- Painful sensation when grasping – Grasping or clutching any bat or other instrument might also intensify the pain sensation.
- Abnormal nerve function – The ulnar nerve is one of the major nerves supplying sensation to the hand and fingers. The nerve passes just around the hook of the hamate, and you will often experience numbness and tingling in the small and ring fingers when the ulnar nerve is not functioning regularly.
Who gets a Hamate Fracture?
Hamate fractures aren’t always the result of a direct force on the hamate bone – other risk factors may also play a role in developing the condition, such as:
Age
In cases of younger patients, there is a period during which bones have grown longer due to growth spurts, however, the bone mineral density hasn’t yet caught up. These can leave newly-grown bones much more vulnerable to fractures. In cases of older adults, they are at a higher risk of a fractured wrist as hormone levels shift and bone mineral density begins to decrease (degeneration), which is the same mechanism that leads to osteoporosis.
Occupational laborers
Working in occupations that require you to climb and/or operate machinery can put you at an increased risk of breaking your hamate bone.
Sports
As mentioned earlier, sports involving clubs, bats, or racquets provide the most consistent cause of hamate bone injuries due to the way in which they encourage the hand to turn and twist at speed. Some of these sports activities include tennis, baseball, and golf.
How Does a Hamate Fracture Affect You? How Serious is it?
In severe cases, the ulnar nerve frequently becomes compressed as a result of hamate fractures. This is due to the location of the hamate at the Guyon canal, close to the motor section of the ulnar artery and nerve.
Another possible complication is an injury to the flexor tendons of the ring and small fingers, interfering with successful flexing because jagged edges of the fracture have ruptured them, thus requiring surgery to repair the area.
Surgery for a hamate fracture can be difficult as the hamate bone is small and often requires pins and screws to be accurately stabilized. Therefore, certain complications with or without surgery are quite rare but they include the following:
- Ongoing stiffness – Stiffness, pain, or aching in the affected wrist normally relieves itself eventually after you have been treated with a cast or after surgery. But you may have permanent stiffness or pain if you leave your fractured lunate bone untreated.
- Nerve or blood vessel damage – Trauma to the wrist can injure adjacent nerves and blood vessels. It is required to seek immediate medical attention if you experience numbness or circulation problems.
- Osteoarthritis – Fractures that extend into a joint can cause arthritis years later.
Recommended Treatment & Rehabilitation for a Hamate Fracture
During a diagnosis of a hamate fracture, a physician will perform a regular diagnostic process, which includes a complete medical history, physical exam, and imaging tests. Your physician will begin by asking you for a detailed description of your current symptoms, how they began to take effect, and what triggered them.
Next, he or she will examine your wrist for any dislocation or discoloration. Your doctor may also test your wrist or ask you to perform hand or wrist movements. Further imaging tests may be ordered to increase the chance of getting a clearer diagnosis for your fractured hamate bone. Some of these tests include:
- Computed Tomography (CT) scan – CT scans can uncover wrist fractures that X-rays usually miss. Injuries to soft tissues and blood vessels can be seen on CT scans.
- Magnetic Resonance Imaging (MRI) – Using radio waves and a powerful magnet to produce detailed images of bone and soft tissues, MRIs are much more sensitive than X-rays and can identify very small fractures and ligament injuries.
After a diagnosis has been successfully done, physiotherapy may be further advised. A physiotherapist will work with you following a hamate fracture to help regain regular wrist motion, strength, and function, and will provide education and training to help you prevent any future injuries.
Therefore, while your bone heals, your arm will be equipped with a cast or sling to keep it still and promote healing. During that time, it is important to ensure that the arm does not get too stiff, weak, or swollen. Depending on the amount of activity that is allowed for your type of fracture, your physiotherapist will prescribe gentle exercises to keep your shoulder, elbow, and fingers moving while you are in the cast or sling.
After your cast is removed, your wrist will most likely feel very stiff, and your arm will feel weaker. Therefore, your therapist will examine your wrist, and design a treatment plan specific to your condition and goals to improve its function and restore strength to your arm. Your treatment will likely include:
Pain management
Your physiotherapist will help you identify and avoid painful movements, and show you how to correct abnormal postures to reduce stress on the wrist. He or she will recommend resting the wrist short-term and applying ice to the area to help alleviate the pain. Your therapist may also apply a wrist brace to restrict wrist movement.
Manual therapy
Your physiotherapist may use manual techniques, such as gentle joint movements, soft-tissue massage, and wrist stretches to get your wrist moving properly.
Range-of-motion exercises
You will learn exercises and stretches to reduce stiffness and help your wrist, hand, and forearm begin to move properly.
Strengthening exercises
Your physiotherapist will determine which strengthening exercises are perfect for you, depending on your specific areas of weakness. Therefore, your therapist will design an individualized home-exercise program to meet your needs and goals.
Patient education
Depending on the activities you plan on continuing, your physiotherapist will teach you different ways to perform actions, while protecting your wrist and hand. For instance, keeping the wrist in a neutral position to reduce excessive force while performing repetitive tasks, and taking frequent breaks are ways to decrease your chances of reinjury.
Below are some examples of exercises for you to try. The exercises may be recommended to reduce symptoms linked to a hamate fracture:
Wrist flexion and extension
Place your forearm on a table, with your hand and affected wrist extended beyond the table, palm down. Next, bend your wrist to move your hand upward and allow your hand to close into a fist, then lower your hand and allow your fingers to relax. Hold each position for 6 seconds, then repeat 8-12 times a day.
Wrist radial and ulnar deviation
Hold your affected hand out in front of you, palm down. Slowly bend your wrist as far as you can from side to side. Hold each position for 6 seconds, then repeat 8-12 times a day.
Hand flips
While seated, place your forearm and affected wrist on your thigh, palm down. Flip your hand over so the back of your hand rests on your thigh and your palm is up. Alternate between palm up and palm down while keeping your forearm on your thigh. Repeat this method 8-12 times a day.
Wrist extensor stretch
Extend your arm with the affected wrist in front of you and point your fingers toward the floor. With your other hand, gently bend your wrist farther until you feel a mild to moderate stretch in your forearm. Hold the stretch for at least 15-30 seconds, then repeat 2-4 times a day.
Wrist flexor stretch
Extend the arm with the affected wrist in front of you with your palm facing away from your body. Then, bend back your wrist, pointing your hand up toward the ceiling. With your other hand, gently bend your wrist farther until you feel a mild to moderate stretch in your forearm. Hold the stretch for at least 15-30 seconds. Repeat this exercise 2-4 times a day.
Alternative & Homeopathic Treatment for Hamate Fracture
If you experience mild symptoms of a fractured hamate bone, you may be able to ease your symptoms with a set of homeopathic treatments. Here are a few home remedies you can try to help recover from a hamate fracture:
- Take breaks from repetitive activities – Whether you are typing, playing guitar, or using a hand drill, try setting a timer beforehand for 15 minutes. When it goes off, stop what you’re doing and wiggle your fingers. Stretch your hands and move your wrists to help improve blood flow to these areas.
- Rest – If you ever find yourself straining or forcing tasks such as writing, typing, or using a cash register, relax your grip or reduce the force you are using. Try using a soft-grip pen or tapping keys more lightly.
- Stay warm – Keeping your wrist and hands warm can help with pain and stiffness. Consider wearing a fingerless glove or keeping hand warmers nearby.
- Non-steroidal anti-inflammatory medications (NSAIDs) – such as ibuprofen, can help reduce further swelling and inflammation.