The ulnar nerve at the hook of hamate level is in zone 2 of Guyon's canal, where the deep motor branch curves around the hook of hamate. Fractures of the hook of hamate directly compress the deep branch at this site, producing pure motor ulnar hand palsy without sensory loss.
Hook of hamate fractures are the classic cause of zone 2 Guyon's canal ulnar nerve compression — pure motor palsy of intrinsic hand muscles with intact ring and little finger sensation. The fracture occurs from direct bat/golf club handle impact. CT wrist identifies the fracture; plain X-rays miss it in 80% of cases. Fragment excision relieves the nerve compression and treats the fracture simultaneously.
Pure motor ulnar palsy from deep branch compression at the hook of hamate producing intrinsic hand weakness without sensory loss, treated by hook excision to decompress the nerve.
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