The pisometacarpal ligament extends from the pisiform to the fifth metacarpal base, completing the FCU tendon's distal force transmission pathway. Together with the pisohamate ligament it forms the two-limbed distal insertion system of the FCU through the pisiform sesamoid. Pisiform excision preserves these ligaments, maintaining functional FCU force transmission.
| Origin | Pisiform |
|---|---|
| Insertion | Base of the fifth metacarpal |
| Actions | Continues FCU force transmission to the fifth metacarpal; provides hypothenar eminence anchorage |
|---|
Following pisiform excision, the pisohamate and pisometacarpal ligaments retain continuity, allowing the FCU to continue transmitting force to the hamate and fifth metacarpal without loss of wrist flexion strength.
Pisometacarpal ligament preserves functional wrist flexion after pisiform excision by maintaining the FCU-to-fifth metacarpal force pathway.
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