Pisiform

Subluxation & dislocation

 

Diagnosis

 

Pisotriquetral view

- forearm positioned 30° supinated off the neutral position

- loss of symmetry between the pisiform and triquetrum is required for the diagnosis

- carpal tunnel view may be helpful in further assessment of the joint

 

Osteoarthritis

 

Clinical

 

More common problem

 

Associated with localized tenderness over the pisotriquetral joint

- usually manipulation of the pisiform over the triquetrum causes intense pain

- local anaesthetic injection into the pisotriquetral joint confirms the diagnosis

 

X-ray

 

Often show loss of joint space and osteophyte formation

 

Management

 

Rest / NSAID's / HCLA pisotriquetral joint

 

Pisiform excision from the FCU tendon sheath