Why does a hook of hamate fracture not show on an X-ray?

On a standard wrist X-ray the hook sits end-on and overlaps other bones, so a crack across it can hide. Doctors use special X-ray views, including the carpal tunnel view, or a CT, which shows it in nearly every case. Which one you need is a decision for your doctor.

Hook of Hamate Fracture: Signs and Recovery

Q: Is a hamate fracture serious?

Found and treated, usually not. A hook that does not join can rub on the flexor tendons of the little finger, which use it as a pulley, and published case series describe those tendons rupturing. Palm pain below the little finger after a swing or a fall needs a doctor, who decides on imaging and treatment.

Q: How long does it take to recover from a hamate bone injury in baseball?

It depends on the treatment. In one study of amateur athletes who had the broken hook removed, the average return to full sport was 6 weeks after the operation. In baseball players who had it removed for a fracture that had not joined, the average return to a game was 11.8 weeks.

Written by Mavis Tham, Principal Hand Occupational Therapist at Phoenix Rehab, AHPC A1800276C.Clinically reviewed by Nigel Chua, Principal Hand Occupational Therapist & Director, AHPC A1300362Z.Last reviewed 7 October 2026.

A hook of hamate fracture is a break in a small hook of bone at the base of the palm, below the little finger. It usually follows a club, bat or racquet handle driven into the palm, or a fall. It aches deep in the palm and hurts to grip. A standard X-ray can miss it. A doctor confirms it.

Key takeaways

The hook of the hamate is a small hook of bone in the palm, below the little finger. It forms one wall of the tunnel the ulnar nerve and artery run through, and one edge of the carpal tunnel.
It breaks when a golf club, bat or racquet handle is driven into the palm, or in a fall on the hand.
The usual signs are a deep ache in the palm below the little finger, pain pressing on that spot, and pain gripping a club, a racquet, a bag handle or the MRT pole.
A standard X-ray can miss it. Special X-ray views or a CT are a decision for your doctor, and the choice between a cast, removing the hook and holding it with a screw belongs to your surgeon.
See a doctor the same day for palm pain that started with one swing or a fall and hurts to press, for numbness or weakness in the little and ring fingers, or for a little finger that suddenly cannot bend at the tip.

What is a hook of hamate fracture?

The hamate is one of the eight small bones of the wrist, on the little-finger side. A hook of bone sticks out from it toward the palm. Find the round bony bump at the heel of your hand on the little-finger side, just above the wrist crease. The hook lies deep under the muscle, a little toward the thumb and the fingers from that bump.

The break is usually across the hook itself, not the body of the bone. Hamate fractures are uncommon, at about 2 to 4% of all wrist bone fractures.¹ Gripping a bat, a racquet, a golf club or a bicycle handle is a common way to break it, along with a fall on the hand.¹

Which nerve is connected to the hook of the hamate?

The ulnar nerve. The hook forms one wall of Guyon’s canal, the short tunnel at the heel of the hand that carries the ulnar nerve and the ulnar artery into the palm. The same hook forms one edge of the carpal tunnel on its other side.¹ The nerve supplies feeling to the little finger and half the ring finger, and the small muscles that spread the fingers apart. That is why a blow to the hook can bring tingling into those two fingers.¹

The pulley for the little and ring fingers

The flexor tendons that bend the ring and little fingers curve around the hook on their way from the forearm to the fingers. The hook works as their pulley.¹ Every hard grip pulls those tendons against it. Several muscles and the ligament across the front of the wrist also attach to it.¹

How it happens, in the order to check

1. The club driven into the ground

The fat shot. The club catches the turf, or a root, or the mat under the range ball, and the butt of the grip drives back into the heel of the hand at the top of the grip. Some golfers feel it at once. Others play on and notice it gripping the club the next weekend. Golf wrist injuries covers the other common one, on the back of the wrist.

2. The knob of the bat: why so many baseball players break the hamate

The knob at the end of the bat sits right on the hook of the bottom hand. A hard swing or a foul tip sends the force through the handle into that one spot. Thousands of swings can also build up a stress fracture.¹ See baseball and softball injuries.

3. The racquet handle in the palm

Tennis, squash, badminton and pickleball. The butt of the racquet presses into the heel of the hand on a hard or mishit shot, and on thousands of ordinary ones. See tennis injuries.

4. Handlebars, or a fall on the hand

A cyclist whose hand takes the handlebar in a crash or a pothole. Anyone who falls on an outstretched hand and lands on the heel of it. A fall usually brings other wrist injuries to check first, so a doctor sees it early.

Hook of hamate symptoms

A deep ache in the palm, below the little finger, at the heel of the hand.
Sharp pain when you press on that spot.
Pain gripping hard: the club, the racquet, the bat, a bag handle, the steering wheel, the MRT pole.
A grip that feels weaker than the other hand.
Pain bending the little and ring fingers hard against resistance.
Sometimes tingling or numbness in the little and ring fingers.¹

Many people call it a bruise, or a sprained wrist, and play on.

Why the first X-ray can look clear

On a standard wrist X-ray, the hook sits end-on and overlaps other bones, so a crack across it can hide. Doctors have special X-ray views that show the hook side-on, including the carpal tunnel view, and a CT shows it in nearly every case.¹ In one series of 8 athletes, 5 needed more detailed imaging before the fracture was found.²

Which of these you need is a decision for your doctor. If the palm still hurts after a clear first X-ray, ask the doctor one question: could this be the hook of the hamate?

Hook of hamate fracture, TFCC, ECU tendon, ulnar nerve or something else?

Ask three things: is the pain in the palm or on the back of the wrist, did it start with one shot or a fall, and do the ring and little fingers tingle.

Condition	Where you feel it	What it does	What it needs first
Hook of hamate fracture	Deep in the palm, below the little finger, at the heel of the hand	Started with one swing, a mishit or a fall. Sharp to press. Hurts to grip	A doctor the same day, and the question about the hook if the X-ray is clear
TFCC tear	The edge of the wrist on the little-finger side, at the end of the forearm bone	Hurts turning the forearm under load and pushing up from a chair. Can click	Assessment. A doctor if it followed a fall
ECU tendon pain	The back of the wrist, little-finger side	Builds over weeks of topspin forehands or golf. Sometimes a snap as the forearm turns	Assessment, a splint and a change in load
Ulnar nerve at the wrist (handlebar palsy)	The palm side of the wrist, little-finger side, into the ring and little fingers	Tingling or numbness after long rides or hours of gripping, sometimes clumsy fingers	A doctor the same day if the fingers are weak. Otherwise a doctor soon
Ulnar nerve at the elbow (cubital tunnel)	The ring and little fingers, sometimes the inner elbow	Tingling worse with the elbow bent, at night or on the phone. No palm pain	Assessment. A doctor if the hand is weak
Hypothenar hammer syndrome	The heel of the hand	From using the heel of the hand as a hammer, or catching. Fingers turn white, blue or cold	A doctor the same day
Jersey finger	The palm side of the ring or little finger	The tip of the finger cannot bend after it was yanked while gripping	A doctor the same day
Wrist sprain	Across the wrist	After a fall. Hurts to move and to lean on, with no single sharp spot in the palm	A doctor and an X-ray if it followed a fall
Scaphoid fracture or wrist fracture	The thumb side of the wrist, or across the end of the forearm	After a fall on the hand. Swelling, and pain moving the wrist	A doctor and an X-ray the same day

Is a hamate fracture serious?

Found and treated, usually not. In the published series of athletes who had the hook removed, the athletes went back to their sport.^4,5 The trouble comes from the hook that is missed.

A missed fracture can heal on its own. It can also stay broken, a nonunion, with or without pain.¹ If the hook does not join, its broken edge sits against the flexor tendons of the little finger, the ones that use the hook as a pulley, and every grip rubs them over it. In published series those tendons have frayed and ruptured. In one series of 8 athletes, 3 had a ruptured flexor tendon by the time the hook was removed, and 2 had tingling from the ulnar nerve.² In another, 6 people had lost the ability to bend the little finger after the tendons ruptured over a hook that had not joined. 5 of the 6 had the tendons rebuilt with a tendon graft, and 1 with a tendon transfer.³

A ruptured tendon needs a hand surgeon. Hand therapy cannot join a bone or reattach a tendon, and nothing on this page replaces that visit. The route is a doctor: your GP, a polyclinic or the emergency department, then a hand surgeon. If the palm still hurts after a clear first X-ray, ask about the hook.

Hook of hamate fracture treatment: who does what

A doctor (your GP, a polyclinic doctor or the emergency department) examines the hand, decides on X-ray views or a CT, and refers you to a hand or orthopedic surgeon.
A hand surgeon decides how the hook is treated. A crack that has not moved, found within the first 3 months, is usually treated first in a cast.¹ Removing the broken hook is a common operation. Holding it with a screw or a wire is another.¹ Which one suits your hand, your sport and how long ago it broke is the surgeon’s decision.
A hand therapist makes the splint if your surgeon prescribes one, works the scar and the grip after the hook is removed, changes the grip on the club or racquet, and tests the return to the swing.

Splint for a hook of hamate fracture

If your surgeon prescribes a splint instead of a plaster cast, or for the weeks after one, a custom thermoplastic splint is shaped by hand at the visit to hold the wrist and the heel of the hand still. Your surgeon decides which joints it holds and for how long. The fingers that the splint leaves free keep moving.

After the hook is removed

The scar sits in the palm, right where you grip. It is often tender to press for some weeks, and the grip is weaker than the other hand. In the Phoenix Recovery Protocol the work starts at Calm & Protect: the wound, swelling and the finger movement your surgeon allows. Move & Mobilize brings back the wrist and finger range, and the scar is worked and desensitized once it has healed. Rebuild & Strengthen loads grip, pinch and the little and ring finger tendons. Return & Perform tests the swing itself: putts, then chips, half swings and full swings, off a mat and then off grass. Racquets and bats follow the same steps: shadow swings, feeding, then a rally or live pitching. Your surgeon’s protocol sets the weeks. See hand therapy after surgery.

A padded grip

A thicker grip, a padded glove, or holding the club so the butt end sits clear of the heel of the hand spreads the pressure off the hook. Your therapist chooses which, and tests it with the club or racquet in your hand.

How long does a hamate fracture take to heal?

In a cast, your surgeon sets the weeks and decides when the cast comes off. After the hook is removed, the bone question is gone, and the wait is for the scar and the grip. In one study of amateur athletes who had the hook removed, they returned to full sport at an average of 6 weeks after the operation.⁴

How long does it take to recover from a hamate bone injury in baseball?

In a series of baseball players who had the hook removed for a fracture that had not joined, the average time back to playing a game was 11.8 weeks.⁵ These are averages from small groups. Your own return depends on the operation, the scar, your grip and your sport, and the four stages test it rather than date it.

What we measure

Tenderness over the hook. Where it hurts to press, against the same spot on the other hand. If the pattern fits a fracture nobody has looked for, we write to your doctor before we treat it.
Grip. In kilograms, on both hands.
Pinch. In kilograms, on both hands.
Little and ring finger bending strength. Each finger bending at the tip against resistance, so a frayed or ruptured tendon is not missed.
The ulnar nerve. Feeling in the tips of the little and ring fingers, and the strength of the small muscles that spread the fingers apart.
Wrist range. In degrees, against the other wrist.
The grip on the club or racquet. How many swings, or minutes of holding it, before the palm aches. This is the number that decides when the full swing comes back.
After surgery. Swelling, the scar and how it tolerates pressure, at every visit.

Tested, not dated. The plan moves on when the measures say so.

What you can do this week

Press deep into the heel of the hand below the little finger, on both hands. If one side is sharp and it started with a swing or a fall, see a doctor.
Write down the date, and the shot, the swing or the fall that started it. A doctor finds it useful.
Stop the swing that hurts: the range, the batting cage, the smash.
Carry bags in the other hand or on the shoulder, and hold the MRT pole with the other hand.
Keep the fingers moving, a full fist and fully open, unless a doctor has put the hand in a cast or a splint.
Pain relief and anti-inflammatory medication are a decision for your doctor or pharmacist.

Is this normal?

Usually expected: after a jarring shot, a bruise-like ache in the palm that eases each day over a week or two, with the grip coming back as it does. In a cast, stiff fingers and a weak grip when the cast comes off. After the hook is removed, a tender scar in the palm for some weeks, some swelling, a grip weaker than the other hand, and a small numb patch near the scar that shrinks.

Worth getting checked: palm pain that is no better after two weeks, even with a clear X-ray. A grip that stays weaker than the other hand from one month to the next. A click or a catch in the palm when the little finger bends. Tingling in the ring and little fingers that comes and goes.

When to see a doctor first

Call 995 if a wound in the palm or wrist is bleeding heavily and firm pressure does not slow it, or after a fall from a bike with a head injury, confusion or neck pain.
Go to the emergency department now if the wrist looks bent or out of place, bone shows through the skin, or the hand or fingers turn cold, pale or blue and stay that way.
See a doctor the same day for palm pain below the little finger that started with one swing, a mishit or a fall and is sharp to press. Also for numbness or weakness in the little and ring fingers after a blow to the palm, a little or ring finger that suddenly cannot bend at the tip, or fingers that turn white, blue or cold and then recover. After surgery, contact your surgeon the same day if the wound is red, leaking or more painful, or you have a fever.
See a doctor soon for palm pain that is no better after two weeks even though the X-ray was clear, tingling in the ring and little fingers after rides or long grips that comes and goes, or a grip that has stayed weaker than the other hand.

Also on this site: the page on Muenster and sugar tong splints covers the two splints that stop the forearm turning after a wrist or forearm fracture.

Where are you with this right now?

1. It was a jarring shot, and it is settling

A fat shot or a mishit jarred the palm. It is a little less sore each day, the grip is coming back, and pressing deep below the little finger is tender rather than sharp. That is a bruised palm behaving as most do. If it is still sharp to press after two weeks, see a doctor and ask about the hook. If not, you do not need us for this, and we would rather say so.

2. The X-ray was clear, and the grip still hurts

It was the seventh hole, a fat shot off a tight lie. The palm stung. The X-ray was clear. You called it a sprain and rested it.

Six weeks on, the driver stays in the bag. You skipped the Saturday flight. The laptop bag goes to the other hand, and on the MRT you hold the pole with the wrong hand without thinking about it. Opening a jar, you turn the lid with the heel of the other palm.

Resting it made sense for a sprain. In your own weeks, rest has not changed how the palm feels on the first hard grip.

What our patients say

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   Micah 
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Amazing experience with Phoenix Rehab, was assisted by Mavis. She’s very kind and professional and did thorough check on my wrist. I feel very comfortable during the process.

I went in for thermoplastic splint, and everything went smoothly. She was able to address my needs on my left wrist sprain.

They were prompt with appointment process and inquiry. Also the clinic is very close to Tanjong Pagar MRT. I highly recommend!
  
 
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Fist time doing ultrasound for my tennis elbow!! Let’s hope it gets better the next few weeks!! Thank Mavis Tham!!
  
 
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   XIN WANG 
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Great treatment from my therapist. My painful wrist felt a lot of relief after the session. I’m glad I can slowly get back to doing my usual activities without constant pain.
  
 
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The masseur is very professional and provides excellent service ，yati is very good!
  
 
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I wasn’t able to close my fingers due to an injury. Nurul at Phoenix Rehab has helped me tremendously with my recovery process. I have been able to resume my daily activities and exercises after only a few sessions. Nurul has been very professional and positive throughout the entire process. Thank you so much for your help!
  
 
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Huge shoutout to Yuna Zhang from Phoenix Rehab for helping in my recovery from golfer’s elbow 🙌

I walked in with persistent elbow pain that was affecting workouts and everyday tasks, and Yuna immediately made me feel confident I was in the right hands. She took the time to properly assess my condition, explain the root cause, and tailor a treatment plan to my specific needs instead of using a one-size-fits-all approach.

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The X-ray was clear. Has anyone pressed on the hook and measured your grip against the other hand?

If nobody has asked about the hook, that question goes to a doctor first, through your GP or a polyclinic. If a doctor has looked and you still cannot grip, one Assessment & Treatment with a hand therapist presses over the hook, tests each finger tendon and the ulnar nerve, measures grip against the other hand, and if the pattern fits a fracture, we write to your doctor that day. If it does not, we treat what limits the grip and set the stages back to the full swing.

3. You have had surgery on the hook, or you are in a cast

The surgeon deals with the bone. The weeks after decide how the scar takes pressure and how hard the hand can grip. See hand therapy after surgery. Your surgeon’s protocol takes precedence. If a tendon was rebuilt as well, see the Flexor Tendon Repair Recovery Program.

If it is months on and the scar still stops the grip, or the club still comes out of your hand on the full swing, the Stalled Recovery Review is three weeks with the same hand therapist. The first visit measures the grip, the scar and the swing. The next two measure how they respond.

All of it runs on the same four stages. The Phoenix Recovery Protocol explains what each stage works on and what you have to meet to move up. No referral needed to start.

Next step

Find out which stage you are in

Pain is the first thing to leave. Movement and strength are the last things trained back, and most people stop before that part is done. One Assessment and Treatment is a single 45-minute appointment at $230, nett, no GST. Your therapist finds what is actually limiting you, treats it in the same appointment, and you leave with your current stage and a written plan.

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