Fractures are Not the Only Bone Injury

​A ballplayer had jumped and stretched for the ball but missed. Descending toward the ground, he put out his right hand to protect his face from hitting the pavement. The pain in the hypothenar eminence and lateral wrist was immediate, but he thought he could shake it off. A few hours later, though, he came in with pain in the lateral wrist, difficulty with full supination, inability to bear weight on the ulnar-deviated wrist when placing his hand on the bed and trying to push himself up, and a superficial abrasion on the hypothenar eminence.​Hypothenar eminence sports injuries are well known to be the cause of pisiform (blue circle) or hook of the hamate (red line) fractures. Two mechanisms are commonly reported — a direct blow or the impact when a loosely held bat (or racket) is kicked back into the palm. He didn't have point palmar tenderness, but I was compelled to look closely at the external oblique — the best view of these carpal bones. I then noticed the sclerotic circle in the hamate on the PA projection, further assuring myself that the base of the hook was intact.Showing the patient his images, I told him that there was no fracture — not of the pisiform, the hamate, the ulnar styloid, or any other bone. The ulna was snuggled in the radial sigmoid notch just as it should be at the distal radioulnar joint. He blurted out, "That big gap there (blue triangle). Is it supposed to look that way?""Yep, but that is exactly where I think the problem ...
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs