The Sentinel Small Finger: Defining the Uniform Pattern of Spontaneous Tendon Rupture in Hook of Hamate Pathology

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Spontaneous flexor tendon ruptures secondary to hook of the hamate pathology are serious, debilitating injuries. While the causal link between the hamate and tendon attrition is established, the specific sequence of tendon involvement remains absent in the literature. It is currently unknown if specific underlying pathologies predispose patients to distinct rupture patterns or if the progression is random. We hypothesize that these ruptures follow a uniform sequence of attrition, acting as a predictable cascade independent of the underlying pathology or patient demographics. This study aims to define these patterns and demographic associations to improve early diagnosis and prevent progressive tendon loss.

A systematic literature review was performed using PubMed and Medline databases to identify cases of spontaneous flexor tendon ruptures with intra-operatively confirmed hamate pathology. Inclusion criteria were met by 24 studies describing 66 patients. Data regarding demographics, etiology, rupture pattern, and treatment outcomes were extracted and analyzed. Statistical analysis assessed associations between patient characteristics (age, sex), pathology type, and rupture patterns. Categorical variables were compared using Chi-square or Fisher's exact tests, while age distributions were analyzed using the Wilcoxon Rank Sum test to identify significant demographic profiles associated with specific etiologies.

The FDP5 ruptured in all patients (100%), followed by the FDS5 (54.5%) and FDP4 (36.4%), establishing a consistent sequence of attrition. The most common etiologies were hamate roughening (47.0%) and non-union (31.8%). Statistical analysis revealed distinct demographic profiles: patients with fracture or non-union etiologies were significantly younger (median 52 vs. 68 years, p< 0.0001) and predominantly male (p=0.0114) compared to those with other pathologies. However, no statistically significant association was found between the specific hamate pathology and the pattern of subsequent tendon rupture (p>0.05). Treatment utilizing hamate excision with tendon grafting or tenodesis resulted in a 98% return to pre-injury activities.

Spontaneous FDP5 rupture acts as a "sentinel event," reliably predicting the progressive destruction of the FDS5 and FDP4. While the rupture sequence is uniform, the etiology is demographically distinct; younger males are prone to fracture and non-union, whereas older patients present with degeneration. Crucially, the lack of difference in rupture patterns emphasizes that all hamate abnormalities carry a similar risk for multi-tendon failure. Early recognition of isolated FDP5 rupture and hamate excision are critical to prevent sequential tendon loss and morbidity.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 1932

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