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Pisiform excision is an effective and safe treatment for ulnar-sided wrist pain related to the pisotriquetral joint

  • M. V. van BurinkEmail author
  • S. Al Shaer
  • J. van Rossen
  • G. van Couwelaar
  • H. Rakhorst
  • O. T. ZöphelEmail author
Original Paper

Abstract

Background

Pisotriquetral disorders can cause chronic ulnar-sided wrist pain. When conservative treatment is insufficient, pisiform excision can be a solution. There are reports found in the literature describing variable effects of this procedure in small, descriptive case series.

Methods

This study included 175 patients who underwent pisiform excision performed in various specialized private hand clinics between 2011 and 2015. Patients were analyzed using standardized outcome measurements.

Results

Functionality was improved significantly 3 months postoperative, with a decrease in pain (n = 86) (P < 0.05), mean improvement of 13 degrees in wrist flexion/extension (n = 72) (P < 0.001), and 18% increase in strength (n = 75) (P < 0.001). Twelve months postoperatively, the wrist function (PRWHE-DLV) improved from a mean of 64 to 25 (n = 62) (P < 0.001).

Conclusions

The results support pisiform excision as an effective and safe treatment. Significant pain relief can be expected with improvement in wrist function. Unfortunately, a high amount of data was missing. The authors believe that the data presented in the study represents an underestimation of the results.

Level of evidence: Level III, therapeutic study.

Keywords

Pisiform excision Pisiform bone Wrist pain Pisotriquetral joint osteoarthritis Flexor carpi ulnaris tendinitis Ulnar neuropathy 

Notes

Acknowledgments

Hand-Wrist Study Group2, Hand-Wriststudygroup@gmail.com: R Feitz, A Fink, TM Moojen, H Slijper, HL de Boer, J Debeij, N de Haas, G Vermeulen, X Smit, S Souer, E Walbeehm

Statistical analysis: M Brusse-Keizer

Compliance with ethical standards

Patient consent

Patients provided a written consent for the use of their data.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The Medical Ethical Review Committee Twente (Post Office Box 50000, 7500 KA Enschede, The Netherlands; email: metc@mst.nl) approved this study (reference: K16-21) and the data collection was compliant with the principles of the Declaration of Helsinki.

References

  1. 1.
    Beckers A, Koebke J (1998) Mechanical strain at the pisotriquetral joint. Clin Anat. 11(5):320–326CrossRefGoogle Scholar
  2. 2.
    Carroll RE, Coyle MP (1985) Dysfunction of the pisotriquetral joint: treatment by excision of the pisiform. J Hand Surg Am. 10(5):703–707CrossRefGoogle Scholar
  3. 3.
    Kofman KE, Schuurman AH, Mulder MC et al (2016) The pisotriquetral joint: osteoarthritis and enthesopathy. J Hand Microsurg. 06(01):18–25CrossRefGoogle Scholar
  4. 4.
    Yamaguchi S, Viegas SF, Patterson RM (1998) Anatomic study of the pisotriquetral joint: ligament anatomy and cartilagenous change. J Hand Surg Am 23(4):600–606CrossRefGoogle Scholar
  5. 5.
    Belliappa PP, Burke FD (1992) Excision of the pisiform in piso-triquetral osteoarthritis. J Hand Surg British Eur Vol. 17(2):133–136CrossRefGoogle Scholar
  6. 6.
    Blum AG, Zabel J, Batch T, Barbara K, Zhu X, Dautel G (2006) Pathologic conditions of the hypothenar eminence: evaluation with multidetector CT and MR imaging. RadioGraphics 26:1021–1044.  https://doi.org/10.1148/rg.264055114 CrossRefGoogle Scholar
  7. 7.
    Moraux A, Lefebvre G, Pansini V, Aucourt J, Vandenbussche L, Demondion X, Cotten A (2014) Pisotriquetral joint disorders: an under-recognized cause of ulnar side wrist pain. Skeletal Radiol. 43(6):761–773CrossRefGoogle Scholar
  8. 8.
    Palmieri TJ (1982) Pisifform area pain treatment by pisiform excision. J Hand Surg Am. 7(5):477–480CrossRefGoogle Scholar
  9. 9.
    Geissler WB (2001) Carpal fractures in athletes. / Fractures carpiennes chez le sportif. Clin Sport Med. 20(1):167–188CrossRefGoogle Scholar
  10. 10.
    Van Eijzeren J, Karthaus RP (2014) The effect of pisiform excision on wrist function. J Hand Surg Am. 39(7):1258–1263CrossRefGoogle Scholar
  11. 11.
    Campion H, Goad A, Rayan G, Porembski M (2014) Pisiform excision for pisotriquetral instability and arthritis. J Hand Surg Am 39(7):1251–1257.e1CrossRefGoogle Scholar
  12. 12.
    Lam KS, Woodbridge S, Burke FD (2003) Wrist function after excision of the pisiform. J Hand Surg Am. 28(1):69–72CrossRefGoogle Scholar
  13. 13.
    Lautenbach M, Eisenschenk A, Langner I, Arntz U, Millrose M (2013) Comparison of clinical results after pisiformectomy in patients with rheumatic versus posttraumatic osteoarthritis. Orthopedics. 36(10):e1239–e1243CrossRefGoogle Scholar
  14. 14.
    Trail IA, Linscheid RL (1992) Pisiformectomy in young patients. J Hand Surg Am. 17(3):346–348CrossRefGoogle Scholar
  15. 15.
    Coll AM, Ameen JRM, Mead D (2004) Postoperative pain assessment tools in day surgery: literature review. J Adv Nurs. 46(2):124–133CrossRefGoogle Scholar
  16. 16.
    Hamilton GF, McDonald C, Chenier TC (1992) Measurement of grip strength: validity and reliability of the sphygmomanometer and jamar grip dynamometer. J Orthop Sport Phys Ther. 16(5):215–219CrossRefGoogle Scholar
  17. 17.
    Brink SM, Voskamp EG, Houpt P, Emmelot CH (2009) Psychometric properties of the Patient Rated Wrist/Hand Evaluation-Dutch Language Version (PRWH/E-DLV). J Hand Surg Eur Vol. 34(4):556–557CrossRefGoogle Scholar
  18. 18.
    MacDermid JC, Tottenham V (2004) Responsiveness of the disability of the arm, shoulder, and hand (DASH) and patient-rated wrist/hand evaluation (PRWHE) in evaluating change after hand therapy. J Hand Ther. 17(1):18–23CrossRefGoogle Scholar
  19. 19.
    Akl EA, Carrasco-Labra A, Brignardello-Petersen R, Neumann I, Johnston BC, Sun X, Briel M, Busse JW, Ebrahim S, Granados CE, Iorio A, Irfan A, Martínez García L, Mustafa RA, Ramírez-Morera A, Selva A, Solà I, Sanabria AJ, Tikkinen KA, Vandvik PO, Vernooij RW, Zazueta OE, Zhou Q, Guyatt GH, Alonso-Coello P (2015) Reporting, handling and assessing the risk of bias associated with missing participant data in systematic reviews: a methodological survey. BMJ Open. 5(9):e009368CrossRefGoogle Scholar
  20. 20.
    Powney M, Williamson P, Kirkham J, Kolamunnage-Dona R (2014) A review of the handling of missing longitudinal outcome data in clinical trials. Trials. 15(1):237CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Plastic, Reconstructive and Hand SurgeryZiekenhuisgroep TwenteHengeloThe Netherlands
  2. 2.Xpert ClinicHilversumThe Netherlands
  3. 3.Xpert ClinicEnschedeThe Netherlands

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