Conditions
Osteoarthritis
Fracture
Instability
Anatomy
Likely a sesamoid bone within FCU
- articulates with triquetrum
- medial border of Guyon's canal
Osteoarthritis
Clinical
Localized tenderness over the pisotriquetral joint
Manipulation of the pisiform over the triquetrum causes intense pain
LA injection into the pisotriquetral joint confirms the diagnosis
X-ray / CT
Loss of joint space / osteophyte formation
Management
Cortisone injections pisotriquetral joint
Pisiform excision from the FCU tendon sheath
- longitudinal incision
- protect ulna nerve and artery in Guyon's canal
- split FCU
- excise pisiform
- repair FCU
Results
Peters et al J Wrist Surg 2022
- pisiform excision in 9 patients
- rapid improvement in symptoms
- no loss of grip strength or ROM
Carroll et al J Hand Surg Am 1985
- 67 pisiform excision
- complete pain relief in 65/67
Fracture
Mechanism
Direct fall onto wrist
Repetitive microtrauma
Management
Undisplaced - nonoperative care
Displaced
- ORIF
- pisiform excision from FCU sheath
Pisotriquetal instability
Stability
FCU
Ligaments
- pisohamate ligament
- pisometacarpal ligament
- ulnar pisotriquetral ligament
Clinical
Ulna sided pain
Pisotriquetral pain
Instability of pisiform
Xray / MRI / CT
Subluxation
Ligament injury
Management
Pisiform excision