Our Disagreement on "Iceberg View" on the Ulnar Wrist and Clinical Implications

The diagnosis of ulnar-sided wrist symptoms concentrates on distal radioulnar joint and triquetral-hamate joint pathology. I consider this is only looking at the "tip of the iceberg" and ignoring other possible pathologies. In particular, this ignores the role of triquetrohamate and pisotriquetral pathologies. I outline our approaches to these pathologies noting the important ligamentous structures, the clinical presentations, the relevant investigations, and the surgical treatments and outcomes that I have found to be reliable. I would encourage hand surgeons to think more widely about ulnar-sided wrist symptoms, in particular triquetrohamate and pisotriquetral joint instabilities.