Golf is one of the biggest participation sports in the world, and not surprisingly there are a number of injuries that are associated with playing the game. As cited in the introduction, back, elbow, shoulder and wrist injuries are quite common in the game of golf; most of which are well documented and recognised.

An injury which is unique to golf but less well recognised, is a fracture – a small break - of the hamate bone in the base of the hand, or more correctly, in the wrist. The hamate is one of the eight small bones in the wrist, and is located on the little finger side of the hand right near the base. It is an odd shaped bone, with a “hook” that extends into the fleshy part of the palm of the hand. This hook is intimately related to the ulnar nerve and artery, and is vulnerable to injury from impact.

In the standard golf grip, the butt of the club rests upon the hook of the hamate bone of the top hand. In a smooth swing from the fairway or from the light rough this association doesn’t cause a problem.  However, if the ball is in heavy rough or even worse in a rocky area or near buried tree roots, there is a danger of the club-face being precipitously decelerated. If this happens, the butt of the club is forced into the palm of the upper hand, occasionally causing a fracture of the hook of the hamate.

This injury is difficult to diagnose. There is often localised pain in the base of the hand and sometimes a little swelling. There is pain felt with pressure over the area of the hamate, which makes gripping the club difficult. Doctors and physiotherapists should be suspicious if these symptoms are present as this problem is often misdiagnosed as a simple wrist sprain. The diagnosis is clinched by a special magnified X-ray in which the beam of the X-ray is pointed at a right-angle to the hook of the hamate. A CT scan can also help clinch the diagnosis. (See diagram)

Occasionally this fracture can heal with a period of immobilisation. Unfortunately this often leads to chronic pain and tenderness where the butt of the club presses upon the healed fracture and surrounding tissues. More frequently however, surgery is required to remove the fragment of bone, allowing a quicker return to play.

So next time you’re faced with a shot out of rocky or uneven ground, or near the base of a tree, think of your hamate bone. Playing a more judicious shot may save you from an unusual and potentially troublesome fracture.