Sports Rehab Write-Up: CF Mike Trout
We’ve got to hand it to the Angels this year; they’ve been putting out some great performances & find themselves only 4.5 games back from being a Wild Card playoff team. Unfortunately, they’ve caught another tough break. It’s officially been announced that perennial All-Star & 3-time American League MVP Mike Trout suffered a fracture of the hamate bone in his left hand during the Angels’ July 3rd outing against the San Diego Padres.
Now that’s a tough break for sure; aside from the scaphoid bone, carpal bone fractures are pretty rare. According to a 2015 review by Snoap, Habeck, & Ruiter, fractures of non-scaphoid carpal bones make up only about 1.1% of all fractures; taken a step further, the hamate accounts for only 2% of carpal fractures. So how did Trout come away with such a rare injury?
Well, hamate fractures are actually fairly common in baseball players! The hamate is a strangely shaped bone consisting of a wide body & a slim, tooth-shaped, medially-placed hook projecting out towards the palm. If you’re poking around on your wrist, it’s pretty close to that bony protrusion you’ll find on the pinky side. The muscles that make up that meaty portion under your pinky partially attach to it as well.
Next time you’re at the batting cages, try taking note of how regularly your bat makes contact with that area. It’s not hard to imagine how that contact – repetitively & with pro-level intensity – can lead to some damage! So, to be specific – hamate hook fractures are fairly common in all bat, club, & racket athletes (Bachoura et. al, 2013).
In 2021, Alexeev et. al published a study in which they sought to compare two specific grip styles seen in professional baseball players in order to measure the pressure exerted on the hamate hook during batting. The study grew from their hypothesis that, when compared with the traditional batting style, batting while holding the knob of the bat inside of or extremely close to the palm of the hand would lead to higher pressure exerted on the hook of the hamate, and thus, more fractures. They termed this grip style the “palmar hamate grip”.
According to Alexeev’s group, “the accepted mechanism of injury in the [hamate] hook fracture is that of the knob of the bat being driven into the hypothenar aspect of the palm, delivering a direct traumatic blow resulting in fracture of the hook of the hamate.”
Let’s look at Trout’s injury & examine his grip style for reference!
Looks pretty similar to that “palmar hamate grip” that Alexeev’s group wrote about!
So, that gives us some good context regarding the mechanism of injury, but what does this mean for Trout down the line? What type of outcomes can he expect?
Well, in the elite baseball playing population, the literature is generally in favor of surgical excision of the fractured hamate hook (Engler et. al, 2022), which we can assume Trout has undergone, working with the best of the best. Research would also suggest that most players will return to sport within 8 weeks after surgery (Engler et. al, 2022).
“I just talked to Mike [Trout]; he just got out of surgery. He feels great… The surgery went well. We spoke to the doctor a minute ago, but it sounds like everything went great.”
These are the latest updates from Angels manager Phil Nevin, who confirms the 4 to 8 week timeline for Trout’s return. All that being said, getting the surgery is less than half the battle.
Trout’s post-op rehab should start immediately in order to reduce pain & swelling, prevent hand stiffness, and eventually to maximize strength & function. Godspeed to Trout & the Angels training staff; hopefully this time 2-months from now Trout’s back on field hitting homers & helping his team fight for that Wild Card spot!
If you’re interested in applying the literature to your personal situation, Engler et. al have created a 7-week protocol that outlines a generalized approach to post-operative rehab.
If you’re dealing with a similar injury & seeking professional guidance, consult your trusted physical therapist to equip you with the appropriate strength & ROM exercises to get you back in the lineup!
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References & Work Cited
Snoap, T., Habeck, J., & Ruiter, T. (2015). Hamate Fracture. Eplasty, 15, ic28.
Engler, I. D., Barrazueta, G., Colacchio, N. D., Ruchelsman, D. E., Belsky, M. R., & Leibman, M. D. (2022). Excision of Hook of Hamate Fractures in Elite Baseball Players: Surgical Technique and Return to Play. Orthopaedic journal of sports medicine, 10(3), 23259671211038028. https://doi.org/10.1177/23259671211038028
Burleson, A., & Shin, S. (2018). Return to Play After Hook of Hamate Excision in Baseball Players. Orthopaedic journal of sports medicine, 6(10), 2325967118803090. https://doi.org/10.1177/2325967118803090
Alexeev, M., Kane, S. M., & Lourie, G. M. (2021). Pressures Exerted on the Hook of the Hamate in Collegiate Baseball Players: A Comparison of Grips, With Emphasis on Fracture Prevention. Orthopaedic journal of sports medicine, 9(10), 23259671211045043. https://doi.org/10.1177/23259671211045043
Bachoura, A., Wroblewski, A., Jacoby, S. M., Osterman, A. L., & Culp, R. W. (2013). Hook of hamate fractures in competitive baseball players. Hand (New York, N.Y.), 8(3), 302–307. https://doi.org/10.1007/s11552-013-9527-4
