16 March 2014

Science of Baseball: Hook of Hamate Fracture in Competitive Baseball Players

Hook of Hamate Fractures in Competitive Baseball Players
Bachoura et al. 2013


Baseball players are susceptible to a number of specific upper extremity injuries secondary to batting, pitching, or fielding. Fractures of the hook of hamate have been known to occur in batters. The purpose of this study is to present our experience with the surgical management of hook of hamate fractures and their short-term impact on the playing capability of competitive baseball players.


A retrospective chart review was performed on patients with hook of hamate fractures between the years 2000 and 2012. The inclusion criteria were (1) hook of hamate fracture, (2) competitive baseball players, and (3) surgical treatment of the injury. Patient demographics, mechanism of injury, surgical treatment, and outcome were collected from the medical records. Information on return to play was collected from the Internet when applicable.


There were seven male patients that underwent eight procedures. The mechanism of injury was attributed to batting in six cases and rogue pitches in two cases. All surgeries consisted of hamate hook excision and ulnar tunnel decompression. One patient had concomitant carpal tunnel release. The median time between surgery and return to play was 5.7 weeks (range, 4.3 to 10.4 weeks).


The mechanism of hook of hamate fractures in baseball players is predictable, most often developing secondary to repetitive swinging. This injury may occur at all levels of competition. Ulnar tunnel decompression with hook of hamate excision provides good outcomes, with minimal complications and early return to play.
The above study looked at hook of hamate fractures in seven competitive players.  This is the injury that Nick Markakis suffered in May of 2012.  In the study, they looked at seven players ranging from 19 to 26 years old whose level of play ranged from high school to MLB.  One player suffered two breaks that required surgery each time.  Of these total eight incidents, six were the product of swinging while two happened to being hit by a pitch.  Typically treatment involves excision of the hook of hamate and surgically decompression the ulnar tunnel from around the nerve.  All players returned to action within 30 games or were ready for the start of the next season.  Insufficient data was collected to measure impact on power.


In general, the injury is often associated with a quick recovery time (about 5 weeks), but players experiencing lingering weakness with respect to generating power in baseball.  The idea being that the hand itself takes time to be able to firmly grasp the handle.  As far as I am aware, there is no comprehensive study of major leaguers who have had the surgery.  There are decent studies looking at amateurs that found similar levels of performance at the end of the rehabilitation time.

Below is a comparison of Markakis' performance before and after his horn of hamate break in 2012 as well as his performance in 2013.

2012 Before 256 333 452 196

After 335 390 489 154
271 329 356 85
As you can see, his power collapse in 2013 and it did not do that after the hamate break, which suggests all that you have read about that break impacting his power is likely inaccurate.  What is more likely to have impacted Nick was when C.C. Sabathia broke his thumb with a fastball, ending Markakis' season in September.

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