Anatomic Variation of the Hamate Hook as a Potential Risk in Endoscopic Carpal Tunnel Release

The purpose of this study was to investigate the incidence of anomalies in patients who underwent endoscopic carpal tunnel release and their relationship with clinical outcomes.

This retrospective study included 65 hands of 57 patients (8 men and 49 women; mean age, 64.9 years) who underwent endoscopic carpal tunnel release for carpal tunnel syndrome at our hospital between March 2016 and April 2022. The patients were diagnosed with carpal tunnel syndrome based on clinical observations and electrophysiological studies. On T2-weighted magnetic resonance axial images, the height of the hook of the hamate was measured from the bottom to the tip of the hook, and the total height of the hamate was measured from the dorsal surface of the hamate to the tip of the hook. A hook-to-height ratio of less than 0.34 was defined as hypoplastic, and its incidence was investigated. In addition, electrodiagnostic testing of sensory and motor nerve conduction of the median nerve and patient-reported outcome measurements, including Quick Disabilities of the Arm, Shoulder and Hand score, Boston carpal tunnel questionnaire, and visual analog scale score, were investigated at 6 months after surgery. Adverse events were collected from patient records.

The mean hook-to-height ratio was 0.40. Hypoplasia with a ratio ≤0.34 was observed in seven hands (10.8%), and adverse events were observed only in the two cases that had a hypoplastic hook of the hamate (3.07%). The patient-reported outcome measurements and the result of electrodiagnostic testing at 6 months after surgery did not correlate with the height of the hook of the hamate.

The incidence of a hypoplastic hook of the hamate is common in patients with carpal tunnel syndrome, and preoperative evaluation of the morphology of the hooks and indications for endoscopic carpal tunnel release in cases of hypoplastic hooks may help predict adverse events.

Therapeutic Ⅳ.