Pisotriquetral Joint Research Articles

Excision of the pisiform in piso-triquetral osteoarthritis

12 patients with pain in the piso-triquetral region are described. 11 had radiological evidence of osteoarthritis of the piso-triquetral joint, which was confirmed in the nine cases treated by excision of the pisiform. Seven of these had complete relief of symptoms. The clinical findings are constant and relief of pain by conservative treatment is usually only temporary. Ulnar nerve symptoms were present in four patients and these were also relieved by surgery. Excision of the pisiform is a useful operation for this condition, which often remains undiagnosed due to incomplete clinical and radiological evaluation. Full return to normal function is the rule if the problem is not associated with other wrist pathology.

Rupture of the Flexor Tendon Secondary to Osteoarthritis of the Pisotriquetral Joint: Case Report

Attrition ruptures of the flexor tendons in the carpal tunnel are uncommon. A case of rupture of the flexor digitorum profundus tendon to the little finger secondary to osteoarthritis of the pisotriquetral joint is reported. Mechanical attrition against the radial side of the pisiform was thought to be responsible for the rupture.

Piso-triquetral pain syndrome after carpal tunnel release

Hypothenar pain was a major complaint in 1.1% of patients 6 months after operation in 500 consecutive carpal tunnel releases. Pain, discomfort, and loss of grip strength was noticed mostly during activities requiring full hand grip or activities associated with use of the heel of the hand, such as pushing up from a chair, or pushing open a door with the flat palm. The pain originated from the piso-triquetral joint, possibly a result of intercarpal alignment change after carpal tunnel release. Pisiform excision was curative, with complete relief of symptoms and return of strength and dexterity. Awareness of this syndrome and systemic evaluation of the piso-triquetral joint preoperatively and postoperatively, as presented here, are essential in the management of this condition.

Piso-triquetral arthrosis as a cause of rupture of the profundus tendon of the little finger

This case report describes a previously unreported cause of profundus rupture of the little finger due to arthrosis of the piso-triquetral joint. With heightened awareness of this entity, it is hoped that delays in diagnosis will be avoided.

Pathologic conditions of the pisiform and pisotriquetral joint

In eight of sixteen patients with symptomatic pisotriquetral joints the pisiform was excised. A detailed study allowed correlation of the etiologic factors with the pathologic diagnosis. In a similar fashion pathologic-etiologic data were retrieved from 216 cases identified from the world literature and organized into the following four pathologic groups: primary OA (2.3%), secondary OA (48.4%), other arthritides (4.7%), and flexor carpi ulnaris enthesopathy (44.6%). The most common causes were acute and chronic trauma and instability. On the basis of these data, we hypothesized that loss of integrity to the surrounding retinacular structures of the pisiform may lead to instability and thus dysfunction of the joint.

両前腕骨末端骨折を伴った豆状骨脱臼の１例

A case of dislocation of the left pisiform occurred in bilateral fractures of the distal radius with fracture of the right ulna and fracture of the left ulnar styloid was reported.The patient was a 14-year-old male. Closed reduction, pinning and splinting were performed, followed by excellent results. To be exact, this case seemed to be subluxation according to the description of Vasilas. The dislocation or subluxation of the pisotriquetral joint is easily overlooked. Meticulous attention should be paid to this disorder. The roentgenograms in semisupine position elucidate more distinct pathology.

Excision of Pisiform in Pisotriquetral Arthritis

Eight patients (nine cases) with pisotriquetral arthritis were treated by pisiform excision after they had failed to respond to splints, antiinflammatory agents, and local steroid injection. Associated with pisotriquetral arthritis were cases of ulnar neuritis, rheumatoid arthritis, pisotriquetral joint loose bodies, and an anomalous muscle. In seven of eight patients, pisiform excision with release of Guyon's canal afforded prompt relief of pain. A palmar approach was necessary for simultaneous ulnar tunnel release and pisiform excisions. One patient with rheumatoid arthritis required a further operative procedure (Darrach) before pain was eliminated. Pisotriquetral arthritis, diagnosed by clinical and radiographic criteria, may be associated with other disorders, in particular ulnar neuritis. Immobilization, antiinflammatories, and local steroid injections may be of temporary assistance. Pisiform excision produces satisfactory relief of pain.

Pisotriquetral joint dysfunction : Carroll R. E. and Coyle M. P. (1985) Dysfunction of the pisotriquetral joint: treatment by excision of the pisiform. J. Hand Surg.10A, 703

Pisotriquetral joint dysfunction : Carroll R. E. and Coyle M. P. (1985) Dysfunction of the pisotriquetral joint: treatment by excision of the pisiform. J. Hand Surg.10A, 703

Dysfunction of the pisotriquetral joint: Treatment by excision of the pisiform

Sixty-seven painful pisotriquetral joints were treated by excision of the pisiform over a 30-year period. Forty-two patients had a previous history of trauma. Ulnar neuropathy was noted in 22 patients, particularly in those with associated wrist-hand fractures and subluxations or dislocations of the pisiform. The abductor and flexor digiti minimi and the palmar carpal ligament with their common fibrous origin were the most common compressing structures on the ulnar nerve. Chondromalacia was found in 29 and osteoarthritis in 20 pisotriquetral joints. Excision of the pisiform provided complete relief of localized hypothenar pain in 65 wrists with no loss of wrist motion or strength. Neurolysis produced full sensory recovery in all 22 patients and full motor recovery in five of six. No late problems associated with the flexor carpi ulnaris tendon were found after excision of the pisiform.

Computed tomography of the normal soft tissues of the wrist.

Computed tomography and sectional radiography and photography were performed on eight cadaveric wrist specimens in order to define the soft tissue structures of the normal wrist. Three specific levels were analyzed in detail: the levels of the distal radioulnar joint, of the pisotriquetral joint, and of the hook of the hamate. All soft tissues, with the exception of arteries and veins, were well demonstrated with computed tomography. In particular, the contents of both Guyon's canal and the carpal tunnel could be delineated. The position of the extensor carpi ulnaris tendon and sheath could also be evaluated. Contrast opacification of the flexor tendon sheaths and palmar synovial sacs did not contribute to the analysis. Computed tomography appears to be an important imaging modality in the evaluation of significant clinical problems, including the carpal tunnel and ulnar tunnel syndromes and subluxation of the extensor carpi ulnaris tendon.

Nonspecific avascular necrosis of the pisiform bone: A case report

Taking into consideration the enlargement and sclerosis of the entire pisiform bone and the smooth articular surfaces of the pisotriquetral joint, the author has speculated that this may represent a nonspecific avascular necrosis with an as yet unknown cause.

Loose body in the pisotriquetral joint. Report of two cases.

Loose body in the pisotriquetral joint. Report of two cases.

Nonspecific avascular necrosis of the pisiform bone: A case report

Taking into consideration the enlargement and sclerosis of the entire pisiform bone and the smooth articular surfaces of the pisotriquetral joint, the author has speculated that this may represent a nonspecific avascular necrosis with an as yet unknown cause.

Pisotriquetral arthritis: A case report

Degenerative arthritis of the pisotriquetral joint was diagnosed by point tenderness over the pisiform and crepitus elicited by lateral movement of the pisiform on the triquetrum. It was confirmed by a roentgenogram of the wrist (lateral view in 30 degrees supination) and injection of the pisotriquetral joint with local anesthetic. Excision of the pisiform resulted in complete relief of pain.

Chronic overuse injuries of the piso-triquetral joint in racquet game players.

Three squash racquets and one badminton player presented with pain in the base of the hypothenar eminence, due to minor degrees of subluxation of the pisiform bone. Two of them also showed chondromalacia of the articular cartilage of the pisotriquetral joint. All four patients were relieved by excision of the pisiform bone and had returned to their normal daily and sporting activities within three months of their operation.

The articular disc of the hand.

The carpal articular disc have been studied in serial sectioned embryonal and fetal hands. It can be concluded that the articular disc is an extensive fibrous system that comes from the ulnar edge of the distal end of the radius and reaches, bordered by the deep layer of the antebrachial fascia, the base of metacarpal V. In this course, insertions take place into the ulnar aspect of the head of the ulna, into the ulnar styloid process and into the ulnar carpals. Emphasis has been laid upon the fact that the sheath of the m. extensor carpi ulnaris tendon is part of the fibrous system of the disc. The positions of the dorsal tendons seen with respect to the fascial implicate a mutual shift during pronation and supination of the hand. The relations between the so-called ligamentum subcruentum and prestyloid recess have been established, the presence of cartilaginous primordia in the developing dis has been discussed. We come to the conclusion that the evidence for drawing a parallel between phylogenetic and human embryological phenomena is still insufficient. In this connection we have stressed the modus of development of the pisotriquetral joint space.

Roentgen Aspects of Injuries to the Pisiform Bone and Pisotriquetral Joint

Roentgen Aspects of Injuries to the Pisiform Bone and Pisotriquetral Joint

Roentgen Aspects of Injuries to the Pisiform Bone and Pisotriquetral Joint

The anatomy and roentgenography of the pisiform and parapisiform area are briefly reviewed. Thirteen cases of fractures of the pisiform bone are reported and discussed, and the scant literature pertaining to this subject is reviewed. The problem of subluxation of the pisotriquetral joint is analyzed on the basis of the normal kinematics of this joint as revealed by roentgenography, and the findings in the pisotriquetral joint in a group of fractures of the distal part of the radius are reviewed.