A keen golfer presents with chronic pain at the hypothenar eminence aggravated by gripping the club. Radiographs are normal. On examination there is diminished sensation on the palmar aspect of the little and ulnar half of the ring fingers with preserved sensation over the dorsum of the hand. Which fracture must be suspected, and what imaging is most appropriate?

• A Fracture of the pisiform; ultrasound of the wrist
• B Fracture of the hook of the hamate; CT scan of the wrist ✓
• C Fracture of the body of the capitate; MRI of the wrist
• D Fracture of the base of the fifth metacarpal; repeat radiographs with wrist in ulnar deviation

Explanation

Fracture of the hook of the hamate is a classic golf, racquet sport and cycling injury caused by direct butt-end impact. It is frequently invisible on plain films, so CT is the imaging modality of choice. The motor deep branch and sensory superficial branch of the ulnar nerve lie in Guyon's canal immediately adjacent to the hook, explaining the sensory findings. Dorsal hand sensation is spared because the dorsal branch arises proximal to the canal, killing option A.

Reference: Green's Operative Hand Surgery, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.