Arthroscopic resection of arthrosis of the proximal hamate: a clinical and biomechanical study.

Purpose: The purpose of this study was to present a series of patients with arthrosis of the proximal hamate treated by arthroscopic resection. To further investigate this condition a biomechanical study also was undertaken to document the effect this proximal hamate resection has on carpal loading.

Methods: Between 1991 and 2001 there were 23 patients who had arthroscopic proximal hamate resection for the treatment of proximal hamate arthrosis. Twenty-one patients were available for final follow-up evaluation (average, 4.7 y). Patients were evaluated by using a modified wrist score that examined pain relief, patient satisfaction, range of motion, and grip strength. Six cadaver wrists had resection of the proximal hamate. Loads across the carpal and midcarpal joints were documented with pressure-sensitive film before and after proximal hamate resection.

Results: Ninety-five percent of the patients had a type II lunate. Twenty-one of 23 wrists had lunotriquetral tears confirmed on arthroscopic examination. Follow-up evaluation revealed 14 excellent, 4 good, 1 fair, and 2 poor results. Biomechanical studies revealed that resection of 2.4 mm of the proximal hamate unloads the hamatolunate articulation without changing the load at the triquetrohamate joint.

Conclusions: Arthrosis of the proximal pole of the hamate seems to be associated closely with tears of the lunotriquetral joint and may be part of the spectrum of ulnar-sided wrist degeneration. Arthroscopic resection of the proximal pole of the hamate appears to be a useful treatment in patients with symptomatic hamate arthrosis, even in those patients with lunotriquetral laxity.