Pisiform Complex Syndrome and Its Impact on Wrist Pain

Pisiform Complex Syndrome: Causes, Symptoms & Diagnosis Explained

Pisiform ligament complex syndrome, also known as pisotriquetral arthritis, exhibits ulnar palmar wrist pain near the pisiform bone. This occurs due to an injury or damage to the components of this pisiform ligament complex (PLC).

What is the pisiform ligament complex?

The pisiform ligament complex (PLC) is a group of ligaments that attach to the pisiform bone and stabilise your wrist, particularly with your pisotriquetral joint (PT joint). This bone is located on the ulnar side of your wrist and articulates with the triquetrum. The flexor carpi ulnaris tendon (FCU) also plays a role in PLC stability.

What Causes Pain in the Pisiform?

Pain in the pisiform bone can arise from various causes. It is essential to understand these causes, which will help you get a proper diagnosis and treatment from your healthcare provider. Here are some factors that can cause pain in your pisiform bone:

• Trauma or Injury: It is one of the most common causes of pain in the pisiform bone. This can occur due to falls or accidents. Apart from these, repetitive stress injuries can occur from activities that involve wrist movement, such as playing sports or typing.
• Tendonitis: Tendonitis, the inflammation of your tendons that are attached to your pisiform bone, can lead to pain. This is known as pisiform tendonitis, which often results from repetitive motions or overuse of your wrist in activities that require wrist flexion or gripping.   
• Ganglion Cysts: Ganglion cysts can occur near the pisiform bone, resulting in localised pain and discomfort. These are generally benign and not harmful but can create pressure on surrounding tissues, causing pain when moving the wrist or hands. Ganglion cysts frequently originate from the pisotriquetral joint. These cysts can cause localized pain and, if they enlarge, may compress nearby structures like the ulnar nerve.
• Arthritis: Arthritis, particularly osteoarthritis and rheumatoid arthritis, can cause pain in the pisiform bone of the wrist. This occurs due to the breakdown of cartilage and inflammation in your pisio-triquetral joint, where your pisiform and triquetrum bones articulate. Cartilages that cushion these joints gradually wear away due to overuse and age.
• Pisiform Fracture: The pisiform bone forms the radial border of Guyon's canal, a passageway for the ulnar nerve and artery. Fractures in this area can worsen the pain, as they can compress or irritate the ulnar nerve within the canal. The severity and nature of fractures can impact the level of pain.

What is the treatment for pisiform arthritis?

Treatment for pisiform arthritis aims to reduce pain and inflammation, along with improving function. Initially, doctors provide conservative treatments like immobilisation, steroid injections, and pain medications.

Let us discuss in detail regarding different conservative management treatment methods to treat pisiform complex syndrome:

• Immobilisation: Doctors use a splint or cast to rest the wrist and reduce stress on the joint.
• Pain Medications: Over-the-counter non-steroidal drugs like naproxen or ibuprofen can manage intense pain in the wrist.
• Steroid Injections: Sometimes, doctors inject corticosteroids directly into the affected joint to reduce inflammation and pain.
• Heat and Cold Therapy: Applying ice or heat packs can help manage pain and inflammation in joint regions.
   

What is the surgical technique for pisiform excision?

If the above-mentioned methods fail to provide adequate relief, doctors may prescribe surgical procedures, such as pisiform excision or pisotriquetral arthrodesis. In this section, we will discuss a step-by-step surgical technique of pisiform excision in detail:
 

1. Incision and Exposure: Doctors create a volar incision over the pisiform of a patient, extending through the skin and subcutaneous tissue. After this, they identify their FCU tendon, following distally to their pisiform.
2. FCU Tenotomy and Pisiform Removal: The FCU tendon is split in the longitudinal direction to isolate the pisiform. It is then carefully removed while identifying and protecting the ulnar neurovascular bundle.
3. Closure and Postoperative Care: In the final stage, doctors approximate the FCU tendon with sutures to restore its integrity. Finally, they place that patient in a palmar splint for a certain period.
    

You can consider surgical options if conservative methods do not show effective results. Pisiform excision is a well-established procedure with effective results. This procedure reliably relieves pain. Most patients regain full wrist motion and near-normal grip strength after a period of postoperative rehabilitation.