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Skeletal Radiology

, Volume 43, Issue 6, pp 761–773 | Cite as

Pisotriquetral joint disorders: an under-recognized cause of ulnar side wrist pain

  • A. MorauxEmail author
  • G. Lefebvre
  • V. Pansini
  • J. Aucourt
  • L. Vandenbussche
  • X. Demondion
  • A. Cotten
Review Article

Abstract

Pisotriquetral joint disorders are often under-recognized in routine clinical practice. They nevertheless represent a significant cause of ulnar side wrist pain. The aim of this article is to present the main disorders of this joint and discuss the different imaging modalities that can be useful for its assessment.

Keywords

Pisiform Pisotriquetral joint diseases Radiography Sonography CT Scan Magnetic resonnance imaging (MRI) 

Notes

Conflict of interest

The authors declare that they have no conflicts of interest.

References

  1. 1.
    May O. The pisiform bone: sesamoid or carpal bone? Ann Chir Main Memb Super. 1996;15(4):265–71.PubMedCrossRefGoogle Scholar
  2. 2.
    Michelson N. Studies in physical development: the ossification time of the os pisiform. Hum Biol. 1945;1945(17):142–6.Google Scholar
  3. 3.
    Pevny T, Rayan GM, Egle D. Ligamentous and tendinous support of the pisiform, anatomic and biomechanical study. J Hand Surg [Am]. 1995;20(2):299–304.CrossRefGoogle Scholar
  4. 4.
    Yamaguchi S, Viegas SF, Patterson RM. Anatomic study of the pisotriquetral joint: ligament anatomy and cartilagenous change. J Hand Surg Am. 1998;23(4):600–6.PubMedCrossRefGoogle Scholar
  5. 5.
    Theumann NH, Pfirrmann CW, Chung CB, Antonio GE, Trudell DJ, Resnick D. Pisotriquetral joint. Assessment with MR imaging and MR arthrography. Radiology. 2002;222(3):763–70.PubMedCrossRefGoogle Scholar
  6. 6.
    Rayan GM. Pisiform ligament complex syndrome and pisotriquetral arthrosis. Hand Clin. 2005;21(4):507–17.PubMedCrossRefGoogle Scholar
  7. 7.
    Rayan GM, Jameson BH, Chung KW. The pisotriquetral joint: anatomic, biomechanical, and radiographic analysis. J Hand Surg Am. 2005;30(3):596–602.PubMedCrossRefGoogle Scholar
  8. 8.
    Buck FM, Gheno R, Nico MA, Haghighi P, Trudell DJ, Resnick D. Ulnomeniscal homologue of the wrist: correlation of anatomic and MR imaging findings. Radiology. 2009;253(3):771–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Beckers A, Koebke J. Mechanical strain at the pisotriquetral joint. Clin Anat. 1998;11(5):320–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Denman EE. The anatomy of the space of Guyon. Hand. 1978;10(1):69–76.PubMedCrossRefGoogle Scholar
  11. 11.
    Ombaba J, Kuo M, Rayan G. Anatomy of the ulnar tunnel and the influence of wrist motion on its morphology. J Hand Surg Am. 2010;35(5):760–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Pierre A, Le Nen D, Hu W, Dubrana F, Saraux A, Chaise F. Treatment of piso-triquetral pain by excision of the pisiform: report of fifteen cases. Chir Main. 2003;22(1):37–42.PubMedCrossRefGoogle Scholar
  13. 13.
    Seradge H, Seradge E. Piso-triquetral pain syndrome after carpal tunnel release. J Hand Surg Am. 1989;14(5):858–62.PubMedCrossRefGoogle Scholar
  14. 14.
    Carroll RE, Coyle Jr MP. Dysfunction of the pisotriquetral joint: treatment by excision of the pisiform. J Hand Surg Am. 1985;10(5):703–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Belliappa PP, Burke FD. Excision of the pisiform in piso-triquetral osteoarthritis. J Hand Surg Br. 1992;17(2):133–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Blum AG, Zabel JP, Kohlmann R, et al. Pathologic conditions of the hypothenar eminence: evaluation with multidetector CT and MR imaging. Radiographics. 2006;26(4):1021–44.PubMedCrossRefGoogle Scholar
  17. 17.
    Wick MC, Weiss RJ, Arora R, et al. Enthesiopathy of the flexor carpi ulnaris at the pisiform: findings of high-frequency sonography. Eur J Radiol. 2011;77(2):240–4.PubMedCrossRefGoogle Scholar
  18. 18.
    Moraux A, Vandenbussche L, Demondion X, Gheno R, Pansini V, Cotten A. Anatomical study of the pisotriquetral joint ligaments using ultrasonography. Skeletal Radiol. 2012;41(3):321–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Seror P, Lestrade M, Vacher H. Ulnar nerve compression at the wrist by a synovial cyst successfully treated with percutaneous puncture and corticosteroid injection. Jt Bone Spine. 2000;67(2):127–8.Google Scholar
  20. 20.
    Pessis E, Drape JL, Bach F, Feydy A, Guerini H, Chevrot A. Direct arthrography of the pisotriquetral joint. AJR Am J Roentgenol. 2006;186(3):800–4.PubMedCrossRefGoogle Scholar
  21. 21.
    Yoshioka H, Ueno T, Tanaka T, Shindo M, Itai Y. High-resolution MR imaging of triangular fibrocartilage complex (TFCC): comparison of microscopy coils and a conventional small surface coil. Skeletal Radiol. 2003;32(10):575–81.PubMedCrossRefGoogle Scholar
  22. 22.
    Yoshioka H, Burns JE. Magnetic resonance imaging of triangular fibrocartilage. J Magn Reson Imaging. 2012;35(4):764–78.PubMedCrossRefGoogle Scholar
  23. 23.
    Watanabe A, Souza F, Vezeridis PS, Blazar P, Yoshioka H. Ulnar-sided wrist pain. II. Clinical imaging and treatment. Skeletal Radiol. 2010;39(9):837–57.PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Lenk S, Ludescher B, Martirosan P, Schick F, Claussen CD, Schlemmer HP. 3.0-T high-resolution MR imaging of carpal ligaments and TFCC. Rofo. 2004;176(5):664–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Saupe N. 3-Tesla high-resolution MR imaging of the wrist. Semin Musculoskelet Radiol. 2009;13(1):29–38.PubMedCrossRefGoogle Scholar
  26. 26.
    Saupe N, Prussmann KP, Luechinger R, Bosiger P, Marincek B, Weishaupt D. MR imaging of the wrist: comparison between 1.5- and 3-T MR imaging–preliminary experience. Radiology. 2005;234(1):256–64.PubMedCrossRefGoogle Scholar
  27. 27.
    Jacobs LG. Isolated fracture of the pisiform bone; a case report. Radiology. 1948;50(4):529–31.PubMedGoogle Scholar
  28. 28.
    Vasilas A. Roentgen aspect of injuries to the pisiform bone and pisotriquetral joint. J Bone Joint Surg. 1960;42:1317–28.Google Scholar
  29. 29.
    O'Shea K, Weiland AJ. Fractures of the hamate and pisiform bones. Hand Clin. 2012;28(3):287–300. viii.PubMedCrossRefGoogle Scholar
  30. 30.
    Fleege MA, Jebson PJ, Renfrew DL, Steyers Jr CM. el-Khoury GY. Pisiform fractures. Skeletal Radiol. 1991;20(3):169–72.PubMedCrossRefGoogle Scholar
  31. 31.
    Lacey JD, Hodge JC. Pisiform and hamulus fractures: easily missed wrist fractures diagnosed on a reverse oblique radiograph. J Emerg Med. 1998;16(3):445–52.PubMedCrossRefGoogle Scholar
  32. 32.
    Israeli A, Engel J, Ganel A. Possible fatigue fracture of the pisiform bone in volleyball players. Int J Sports Med. 1982;3(1):56–7.PubMedCrossRefGoogle Scholar
  33. 33.
    Welling RD, Jacobson JA, Jamadar DA, Chong S, Caoili EM, Jebson PJ. MDCT and radiography of wrist fractures: radiographic sensitivity and fracture patterns. AJR Am J Roentgenol. 2008;190(1):10–6.PubMedCrossRefGoogle Scholar
  34. 34.
    Aiki H, Wada T, Yamashita T. Pisotriquetral arthrosis after triquetral malunion: a case report. J Hand Surg Am. 2006;31(7):1157–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Suzuki T, Nakatsuchi Y, Tateiwa Y, Tsukada A, Yotsumoto N. Osteochondral fracture of the triquetrum: a case report. J Hand Surg Am. 2002;27(1):98–100.PubMedCrossRefGoogle Scholar
  36. 36.
    Immermann EW. Dislocation of the pisiform. J Bone Joint Surg Am. 1948;30A(2):489–22.PubMedGoogle Scholar
  37. 37.
    Fabre A, Le Nen D, Casse JP, Hu W, Colin D. L'angle piso-métacarpien: application au diagnostic de luxation du pisiform. La Main. 1999;4(4):253–62.Google Scholar
  38. 38.
    Steinmann SP, Linscheid RL. Pisotriquetral loose bodies. J Hand Surg Am. 1997;22(5):918–21.PubMedCrossRefGoogle Scholar
  39. 39.
    Katolik LI. Arthroscopic resection of pisotriquetral joint loose body: a case report. J Hand Surg Am. 2008;33(2):206–9.PubMedCrossRefGoogle Scholar
  40. 40.
    Moreel P. Osteoarthritic degeneration of the pisiform-triquetral joint. J Traumatol Sports. 2005;2005(22):102–6.CrossRefGoogle Scholar
  41. 41.
    Lautenbach M, Eisenschenk A, Langner I, Arntz U, Millrose M. Comparison of clinical results after pisiformectomy in patients with rheumatic versus posttraumatic osteoarthritis. Orthopedics. 2013;36(10):e1239–43.PubMedGoogle Scholar
  42. 42.
    Abrams R, Tontz W. Pisotriquetral arthrodesis as an alternative to excision for pisotriquetral instability in high-demand patients: a case report in a gymnast. J Hand Surg Am. 2006;31(4):611–4.PubMedCrossRefGoogle Scholar
  43. 43.
    Singer G, Eberl R, Hoellwarth ME. Pisotriquetral arthrodesis for pisotriquetral instability: case report. J Hand Surg Am. 2011;36(2):299–303.PubMedCrossRefGoogle Scholar
  44. 44.
    Le Nen D. Pathology of the piso-triquetral joint: report of 26 cases. Ann Orthop Quest. 2000;2000(32):129–34.Google Scholar
  45. 45.
    Fischer E. Piso-triquetral arthrosis and the so-called pisiform secundarium. Radiology. 1988;28(7):338–44.Google Scholar
  46. 46.
    Paley D, McMurtry RY, Cruickshank B. Pathologic conditions of the pisiform and pisotriquetral joint. J Hand Surg Am. 1987;12(1):110–9.PubMedCrossRefGoogle Scholar
  47. 47.
    Lam KS, Woodbridge S, Burke FD. Wrist function after excision of the pisiform. J Hand Surg Br. 2003;28(1):69–72.PubMedCrossRefGoogle Scholar
  48. 48.
    Seror P, Vuillemin V. Ulnar nerve lesion at the wrist related to pisotriquetral joint arthropathy. Muscle Nerve. 2013;47(4):600–4.PubMedCrossRefGoogle Scholar
  49. 49.
    Jenkins SA. Osteoarthritis of the pisiform-triquetral joint; report of three cases. J Bone Joint Surg Br. 1951;33-B(4):532–4.PubMedGoogle Scholar
  50. 50.
    Krag C. Osteoarthritis of the piso-triquetral articulation. Hand. 1974;6(2):181–4.PubMedCrossRefGoogle Scholar
  51. 51.
    Vastamaki M. Pisiform-triquetrial osteoarthritis as cause of wrist pain. Ann Chir Gynaecol. 1986;75(5):280–2.PubMedGoogle Scholar
  52. 52.
    Helal B. Chronic overuse injuries of the piso-triquetral joint in racquet game players. Br J Sports Med. 1978;12(4):195–8.PubMedCentralPubMedCrossRefGoogle Scholar
  53. 53.
    Rodineau J, Rolland E. Pisotriquetral joint diseases. In: Masson, editor. Pathologie intra- et péritendineuse du membre supérieur des sportifs. Paris: Elsevier Masson; 2006.Google Scholar
  54. 54.
    Sundaram M, Shively R, Patel B, Tayob A. Isolated dislocation of the pisiform. Br J Radiol. 1980;53(633):911–2.PubMedCrossRefGoogle Scholar
  55. 55.
    Saint-Cyr M, Kleinert HE. Compression of the ulnar nerve and spasm of the ulnar artery in Guyon's canal caused by a hypermobile pisiform bone. Scand J Plast Reconstr Surg Hand Surg. 2008;42(4):215–7.PubMedCrossRefGoogle Scholar
  56. 56.
    Corten EM, van den Broecke DG, Kon M, Schuurman AH. Pisotriquetral instability causing an unusual flexor tendon rupture. J Hand Surg Am. 2004;29(2):236–9.PubMedCrossRefGoogle Scholar
  57. 57.
    Chen WA, Barnwell JC, Li Y, Smith BP, Li Z. An ulnar intraneural ganglion arising from the pisotriquetral joint: case report. J Hand Surg Am. 2011;36(1):65–7.PubMedCrossRefGoogle Scholar
  58. 58.
    Hayes JR, Mulholland RC, O'Connor BT. Compression of the deep palmar branch of the ulnar nerve. Case report and anatomical study. J Bone Joint Surg Br. 1969;51(3):469–72.PubMedGoogle Scholar
  59. 59.
    Burnett SE. Hamate-pisiform coalition. Morphology, clinical significance, and a simplified classification scheme for carpal coalition. Clin Anat. 2011;24(2):188–96.PubMedCrossRefGoogle Scholar
  60. 60.
    Saylisoy S, Akcan E, Atlanoglu S, Calisir C, Inan U, Oztunali C. Incomplete left-hand and complete right-hand pisiform and hamate coalition: multidetector computed tomography findings. Jpn J Radiol. 2011;29(4):276–8.PubMedCrossRefGoogle Scholar
  61. 61.
    Tsionos I, Drape JL, Le Viet D. Bilateral pisiform-hamate coalition causing carpal tunnel syndrome and tendon attrition. A case report. Acta Orthop Belg. 2004;70(2):171–6.PubMedGoogle Scholar
  62. 62.
    Louaste J, Amhajji L, Rachid K. Pisiform-hamate synostosis with ulnar neuropathy. Case report. Chir Main. 2007;26(3):170–2.PubMedCrossRefGoogle Scholar
  63. 63.
    Chikura B. Pisiform hypertrophy. A radiological feature of psoriatic arthritis. J Clin Rheumatol. 2011;17(2):109.PubMedCrossRefGoogle Scholar
  64. 64.
    Freedman DM, Botte MJ, Gelberman RH. Vascularity of the carpus. Clin Orthop Relat Res. 2001;383:47–59.PubMedCrossRefGoogle Scholar
  65. 65.
    Garcia LA, Vaca JB. Avascular necrosis of the pisiform. J Hand Surg Br. 2006;31(4):453–4.PubMedCrossRefGoogle Scholar
  66. 66.
    Match RM. Nonspecific avascular necrosis of the pisiform bone: a case report. J Hand Surg Am. 1980;5(4):341–2.PubMedCrossRefGoogle Scholar

Copyright information

© ISS 2014

Authors and Affiliations

  • A. Moraux
    • 1
    • 3
    Email author
  • G. Lefebvre
    • 1
  • V. Pansini
    • 1
  • J. Aucourt
    • 1
  • L. Vandenbussche
    • 1
  • X. Demondion
    • 1
    • 2
  • A. Cotten
    • 1
  1. 1.Service d’Imagerie Musculo-Squelettique, Centre de consultation de l’appareil locomoteurHôpital Roger SalengroLille CedexFrance
  2. 2.Laboratoire d’AnatomiePôle Recherche Faculté de Médecine de LilleLille CedexFrance
  3. 3.Imagerie Médicale Jacquemars GiéléeLilleFrance

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