The flexor carpi ulnaris tendon runs along the ulnar border of the wrist to insert onto the pisiform, with extensions to the hamate (pisohamate ligament) and fifth metacarpal (pisometacarpal ligament). It is the primary wrist flexor and ulnar deviator, and its tendon forms the roof of Guyon's canal at the wrist.
The FCU tendon forms the fibrous roof of Guyon's canal, through which the ulnar nerve and artery pass. FCU tendinopathy at the pisiform produces ulnar-sided wrist pain reproduced by resisted wrist flexion and ulnar deviation. Calcific FCU tendinopathy at the pisiform is a recognised cause of acute ulnar wrist pain. Pisiform excision for pisotriquetral arthritis requires FCU tendon reattachment to the flexor retinaculum.
Degenerative or calcific change at the FCU pisiform insertion producing ulnar wrist pain with resisted flexion, managed with activity modification, injection, or pisiform excision for pisotriquetral arthritis.
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