The pisotriquetral joint is a small plane synovial joint between the pisiform (a sesamoid bone embedded in the FCU tendon) and the palmar surface of the triquetrum. It is unique among carpal joints in being a sesamoid articulation, with the pisiform acting as a pulley bone to increase the mechanical advantage of the FCU for wrist flexion and ulnar deviation. The joint cavity communicates with the wrist joint in approximately 40% of individuals.
Pisotriquetral arthritis produces ulnar-sided wrist pain reproduced by direct pisiform compression and by passive pisotriquetral stress testing (shear movement of the pisiform on the triquetrum). CT or MRI demonstrates articular narrowing, subchondral sclerosis, and cystic change in the pisotriquetral joint. Conservative management includes corticosteroid injection into the joint under ultrasound guidance. Pisiform excision (through a medial carpal tunnel incision, dividing the FCU to expose the pisiform) provides definitive relief for refractory pisotriquetral arthritis, with full FCU function maintained because the pisiform contribution is modest.
Degenerative arthritis of the pisotriquetral joint from direct trauma or repetitive loading produces ulnar wrist pain exacerbated by wrist flexion and ulnar deviation; pisotriquetral stress testing by shearing the pisiform on the triquetrum reproduces the pain; corticosteroid injection provides temporary relief and pisiform excision is curative for refractory cases.
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