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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