Abstract
Background: A 21-year-old male collegiate baseball player underwent successful excision of the hook of hamate of the left hand. Following two weeks in a padded splint to allow for appropriate scar healing, the patient’s sutures were removed and rehabilitation was initiated. Initial rehabilitation consisted of passive range of motion exercises progressing to active range of motion exercises. After one week of range of motion exercises and improvement of range of motion, resistance training with blood flow restriction was initiated. Differential Diagnosis: Hook of the hamate excision. Treatment: Week 3: Prior to beginning resistance training with blood flow restriction, grip strength was assessed using a handheld dynamometer. The average of the patient’s three trials for his surgery hand was 60.6 pounds. The average for the non-surgery hand was 145.8 pounds. The average Resistance exercised consisted of theraputty gripping, resisted pronation and supination, and resisted wrist flexion and extension. All exercises were performed with 50% blood flow restriction for one set of 30 repetitions followed by three sets of 15 repetitions with 30 second breaks between repetitions and 60 second breaks between exercises. Exercises were performed five days during the week. Week 4: The average of the patient’s grip strength trials for his surgery hand was 82.4 pounds, and 144.5 pounds for his non-surgery hand. Level of resistance for exercises was increased to tolerance with sets, repetitions and frequency remaining the same. Week 5: The average of the patient’s grip strength trials for his surgery hand was 121.4 pounds, and 145.6 pounds for his non-surgery hand. Level of resistance for exercises was increased again, and the patient began sport specific activities including hitting and catching. Given the increase in sport specific activity, resistance training frequency was decreased to three times during the week. Week 6: The average of the patient’s grip strength trials for his surgery hand was 130.8 pounds, and 145.2 pounds for his non-surgery hand. The patient returned to full participation in team activities, with a plan to continue therapeutic exercises three times a week. Uniqueness: While the patient’s return to play following hamate excision was consistent with current literature, recent data has suggested that patients undergoing hook of the hamate excision experience a reduction in grip strength post-surgery. In this case, the patient improved his grip strength by 115.8% within four weeks of splint and suture removal. This case provides an example of a successful therapeutic exercise protocol for increasing grip strength using blood flow restriction following hook of the hamate excision. Conclusions: When developing a therapeutic exercise protocol for a patient after injury or surgery, it is important to explore all possible options to ensure optimal patient outcomes. As this report describes only one hook of the hamate excision patient’s outcomes following therapeutic exercise with blood flow restriction, larger scale studies are necessary to provide more generalizable recommendations.
Recommended Citation
Goza, J P.; Galbraith, R M.; Jacobsen, A P.; Warner, B J.; and Cage, S A.
(2023)
"Use of Blood Flow Restriction Training with a Collegiate Baseball Player Following Hook of the Hamate Excision,"
Clinical Practice in Athletic Training: Vol. 6:
Iss.
3, Article 8.
Available at:
https://scholars.indianastate.edu/clinat/vol6/iss3/8