Pisotriquetral Osteoarthritis and Its Impact on Wrist Function

Pisotriquetral Osteoarthritis: Causes, Symptoms & Diagnostic Stages

Pisotriquetral osteoarthritis is a condition where the protective cartilage in the pisotriquetral joint of the wrist wears down. It typically causes a vague, aching pain on the little finger side of the palm, often without a specific injury. This degeneration can occur with ageing, following a fracture, from repetitive stress, or in conjunction with inflammatory arthritis like rheumatoid arthritis.

How is the Severity of Pisotriquetral Osteoarthritis Assessed?

Unlike osteoarthritis in large weight-bearing joints like the knee, there is no formal numbered staging system for the pisotriquetral joint. Instead, doctors describe its severity in general terms mild, moderate, or severe based on the following:

• Symptoms: The intensity and frequency of pain, stiffness, and functional limitations.
   
• Physical Exam: Findings like tenderness directly over the joint, crepitus (a grinding sensation), and pain with specific movements like resisted wrist flexion.
   
• Imaging: X-ray or CT findings show key degenerative changes:
  
  
  • Mild: Minor joint space narrowing.
  • Moderate: Significant joint space narrowing, sclerosis (increased bone density), and small osteophytes (bone spurs).
  • Severe: Near-complete or complete loss of joint space, large bone spurs, and cystic changes in the bone.
     

This combined assessment guides treatment decisions, from conservative management to surgical intervention.

How Do Doctors Diagnose Pisiform-Triquetral Osteoarthritis?

Diagnosis begins with a discussion of your symptoms and any history of injury or arthritis. The doctor will perform a physical exam, pressing on the pisiform bone and moving your wrist to reproduce the pain. The primary diagnostic tool is an X-ray or CT scan, which can clearly show the characteristic joint space narrowing, sclerosis, and osteophytes of osteoarthritis. An MRI may be used to rule out other soft tissue causes of pain. Blood tests are not used to diagnose osteoarthritis but may be ordered to rule out inflammatory types of arthritis.

What is the treatment for severe pisotriquetral osteoarthritis?

When non-surgical treatments like activity modification, splinting, anti-inflammatory medications, and corticosteroid injections no longer provide adequate relief, surgery is considered.

The primary and most effective surgical treatment for severe pisotriquetral osteoarthritis is pisiform excision. This procedure involves removing the pisiform bone entirely, thereby eliminating the arthritic joint. It is a well-established operation that successfully relieves pain while preserving wrist function and strength. It is highly preferred over other options.

· Joint fusion (arthrodesis) of this joint is rarely performed and is not a standard treatment.

· Joint replacement (arthroplasty) is not a surgical option for the pisotriquetral joint.

What is the Best Management Strategies for Wrist Arthritis?

For pisotriquetral osteoarthritis, management focuses on relieving stress on the joint:
 

• Activity Modification: Avoiding repetitive gripping and activities that pressure the heel of the hand.
• Splinting: A short period of immobilization in a splint can help reduce acute pain and inflammation.
• Exercises: Gentle range-of-motion and strengthening exercises prescribed by a physical or occupational therapist can help maintain overall wrist function without aggravating the pisotriquetral joint. Generic "wrist stretches" may not be appropriate during painful flare-ups.
   

While exercises are crucial for managing general wrist arthritis, they have limited ability to control pain once the pisotriquetral joint is severely damaged. At that point, pisiform excision is often the most reliable option to improve comfort and function.

Pisotriquetral osteoarthritis can cause significant wrist pain. Early diagnosis and proper management can help control symptoms, but in severe cases, pisiform excision surgery is a highly effective treatment to improve daily life.