The pisiform is a sesamoid bone in the FCU tendon, articulating with the triquetrum at the pisotriquetral joint on its dorsal surface. It acts as a lever for the FCU tendon, increasing its mechanical advantage. Pisiform fractures from direct impact or stress fractures produce ulnar palmar wrist pain reproduced by pisiform compression and lateral glide. Pisiform excision is the definitive treatment for pisotriquetral arthritis.
Pisotriquetral arthritis produces ulnar palmar wrist pain reproduced by the pisotriquetral grind test (compression with lateral glide). Injection into the pisotriquetral joint provides diagnostic and therapeutic benefit. Pisiform excision preserves the pisohamate and pisometacarpal ligaments and maintains FCU force transmission.
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