The FCU tendon inserts via the pisiform sesamoid, which redirects the force to the hamate and fifth metacarpal base. This sesamoid mechanism increases the mechanical advantage of the FCU for wrist flexion and ulnar deviation. FCU tendinopathy at the pisiform or pisotriquetral joint produces ulnar palmar wrist pain. The FCU tendon is the surgical landmark for approaches to the ulnar wrist and Guyon's canal.
Wrist flexion and ulnar deviation; the pisiform acts as a sesamoid to change the FCU force direction from linear to angulated
FCU calcific tendinopathy deposits calcium within the tendon at the pisiform level, producing acute ulnar wrist pain. Ultrasound-guided needling and lavage provides rapid relief. The FCU is the most commonly transferred tendon for wrist extension reconstruction in radial nerve palsy (FCU-to-ECRB transfer).
Calcium deposition in the FCU tendon at the pisiform producing acute ulnar wrist pain managed with ultrasound-guided needling and lavage.
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