Challenge of the Week / Sports / 03.19.2021

A 21-year-old male patient who is a collegiate baseball player presents with an acute onset of hand pain that developed after batting practice 3 days ago. He has ulnar-sided pain, grip weakness, and intermittent tingling to his small finger. Which of the following diagnostic modalities will best aid in establishing the correct diagnosis?
    • Elbow radiographs
    • The patient likely has a hook of hamate fracture. Elbow radiographs would be beneficial in the case of ulnar neuropathy-related top compression at the cubital tunnel.

 

    • Wrist radiographs with a carpal tunnel view
    • The patient likely has a hook of hamate fracture. This can be seen on posterior-anterior wrist radiographs as a break in the cortical ring overlying the body of the hamate. The hook of the hamate can be isolated on carpal tunnel views of the wrist.

 

    • Electromyography and nerve conduction studies
    • The patient likely has a hook of hamate fracture. Intermittent paresthesias can be present due to the close proximity of the ulnar nerve running through the Guyon canal, but electromyography and nerve conduction studies would not help in the diagnosis. Grip weakness is typically related to pain.

     

    • Ultrasound of the wrist
    • The patient likely has a hook of hamate fracture. Ultrasonography would be beneficial in cases of a ganglion cyst or ulnar artery thrombosis and aneurysm in the case of ulnar nerve compression at the Guyon canal.

 

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