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.
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.
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