Hamate hook fracture in a 17-year-old golfer: importance of matching symptoms to clinical evidence.

Objective: To describe the importance of correlating symptoms with objective clinical findings and appropriate diagnostic imaging in a patient with traumatic wrist pain.

Clinical Features: A 17-year-old golfer had persistent left wrist pain of 4 months' duration that began while playing golf. Approximately 1 week after injury, he was diagnosed with a scaphoid fracture and was splinted. He reported that his pain did not decrease with splinting or with subsequent physical therapy, and on dismissal from orthopedic care he could not use the wrist well enough to return to golf.

Intervention And Outcome: The patient was found to have marked point tenderness at the hamate. Although plain-film radiography was negative, secondary computed tomography of the wrist showed a fracture to the hook of the hamate. A referral was made to an orthopedic surgeon and surgical excision of the hook of the hamate was recommended because of the failure of union at the fracture site.

Conclusion: This case shows the significance of follow-up diagnostic imaging in a patient who does not respond as expected. In addition, it stresses the importance of the doctor of chiropractic in the diagnostic process, although the patient may have been treated and released by another physician.