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Duke Orthopaedics
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Wheeless' Textbook of Orthopaedics

Pisiform       


- See:
      - Blood Supply to the Wrist

- Discussion:
     - located in anterolateral portion of triquetrium (may be a source of DJD and ulnar wrist pain);
     - pisiform forms medial border of tunnel of Guyon (transporting ulnar nerve and artery);
     - tendinous and ligamentous attachements;
             - FCU tendon: pisiform bone is located w/ in FCU tendon;
             - abductor digiti quinti muscle;
             - pisometacarpal ligament;
             - pisohamate ligament;
             - extensor retinaculum;
             - flexor retinaculum (transverse carpal ligament)

- Radiographs:
    - 15 reversed oblique view:
    - pisotriquetral joint is best seen with 30 deg of wrist supination or utilizing the carpal tunnel view;
    - calcific deposits, which occassionally form at site of insertion of tendon, can cause severe pain;

- Treatment of Frx:
    - pts that sustain frx of pisiform most often go on to heal w/o posttraumatic osteoarthritis;
    - frequently these pts have ulnar neuropathies, esp w/ wrist frxs or subluxation or dislocation of the pisiform;
    - cause of pain about pisiform is chronic calcific tendinitis of FCU;
    - excision of pisiform w/ pain localized to pisotriquetral joint provides almost complete pain relief, w/ minimal reduction of grip strength or motion



Pisiform Kinematics in vivo



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Thursday, December 20, 2012 11:08 pm