Excision of pisiform in pisotriquetral arthritis

Eight patients (nine cases) with pisotriquetral arthritis were treated by pisiform excision after they had failed to respond to splints, antiinflammatory agents, and local steroid injection. Associated with pisotriquetral arthritis were cases of ulnar neuritis, rheumatoid arthritis, pisotriquetral joint loose bodies, and an anomalous muscle. In seven of eight patients, pisiform excision with release of Guyon's canal afforded prompt relief of pain. A palmar approach was necessary for simultaneous ulnar tunnel release and pisiform excisions. One patient with rheumatoid arthritis required a further operative procedure (Darrach) before pain was eliminated. Pisotriquetral arthritis, diagnosed by clinical and radiographic criteria, may be associated with other disorders, in particular ulnar neuritis. Immobilization, antiinflammatories, and local steroid injections may be of temporary assistance. Pisiform excision produces satisfactory relief of pain.