Authors of section

Authors

Pavel Dráč, Matej Kastelec, Fabio A Suarez

Executive Editor

Simon Lambert

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Ulnar approach to the hamate hook

Select a chapter
  • 1/6 – Indication
  • 2/6 – Anatomy
  • 3/6 – Skin incision
  • 4/6 – Deep dissection
  • 5/6 – Preparation of the hamate hook
  • 6/6 – Wound closure

1. Indication

The ulnar approach to the hamate hook is indicated for excision of the hook. It can also be used for excision of the pisiform in case of posttraumatic sequelae.

In some cases, this approach is used to treat acute fractures.

Skin incision during ulnar approach to the hamate hook

2. Anatomy

The hook of hamate contributes to the medial border of the carpal tunnel and lateral border of the Guyon’s canal.

The Guyon’s canal is the interval between the hook of the hamate and the pisiform bone and contains the ulnar artery and nerve.

Location of the carpal tunnel and Guyon’s canal

Attachment to the hook:

  • Pisohamate ligament
  • Flexor retinaculum
  • Musculus opponens digiti minimi and flexor digiti minimi
Attachments to the hamate hook

Anatomical landmarks

  • Flexor carpi ulnaris tendon on the ulnar side of the wrist, which is inserted into the pisiform bone
  • Pisiform bone, palpable distal to the palmar wrist crease
  • Ulnar artery palpated radial to the flexor carpi ulnaris (FCU)
  • Hook of hamate, palpable distal and radial to the pisiform
Anatomical landmarks for ulnar approach to the hamate hook

3. Skin incision

Start the zigzag incision at the level of the distal radioulnar joint (DRUJ) radial to the FCU tendon.

It turns radially at the level of the distal palmar crease at the base of the pisiform.

It then turns ulnar-wards and continues distally as shown.

The incision is about 5 cm long in total.

Skin incision during ulnar approach to the hamate hook

4. Deep dissection

Identify the ulnar artery and nerve in the proximal part of the wound and trace them distally to expose the hook of the hamate.

Divide the fascia antebrachia in the proximal part of the wound.

Deep dissection during ulnar approach to the hamate hook

Divide the palmaris brevis distally.

Dividing the palmaris brevis during ulnar approach to the hamate hook

Retract the ulnar artery and nerve to the ulnar side to protect them.

Retracting the ulnar artery during the ulnar approach to the hamate hook

5. Preparation of the hamate hook

Expose the hook subperiosteally by sharp dissection.

Divide the origin of the flexor digiti minimi brevis (and opponens digiti minimi) and retract it to the ulnar side.

On the radial side of the wound, the flexor digiti minimi tendon can be identified.

Exposing the hook subperiosteally during the ulnar approach to the hamate hook

6. Wound closure

Close the skin in a standard manner.

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