The pisiform is a pea-shaped sesamoid bone embedded within the flexor carpi ulnaris tendon, lying anterior to the triquetrum and forming the medial wall of Guyon's canal through which the ulnar nerve and artery pass.
| Articulations | |
|---|---|
| Landmarks |
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| Ossification | Endochondral ossification from a single centre appearing between ages 8 and 12, the last carpal bone to begin ossification. |
The pisiform is a sesamoid bone within the FCU tendon and is the only carpal bone with a tendon insertion. Its attachment to the FCU means that grip activities and wrist ulnar deviation load it repeatedly. Pisiform fractures from a direct blow to the hypothenar eminence or repetitive trauma produce ulnar-sided wrist pain reproduced by direct pisiform pressure and ulnar wrist motion. Pisotriquetral arthrosis is a common source of ulnar wrist pain in older adults.
Turn the hand palm up and follow the flexor carpi ulnaris tendon on the little-finger side of the wrist down to the distal wrist crease. The small, pea-shaped bone at the base of the hypothenar eminence is the pisiform. With the wrist relaxed in slight flexion it can be moved gently side to side.
A direct blow to the hypothenar eminence, for example from a fall or racquet, can fracture the pisiform; it may be associated with ulnar nerve symptoms in Guyon's canal.
Degeneration of the pisotriquetral joint causes ulnar palmar wrist pain aggravated by gripping and wrist flexion.
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