Pisotriquetral loose bodies

Eight patients--2 men and 6 women (mean age, 49 years)--who underwent excision of pisotriquetral (PT) loose bodies were identified from clinic records. The time interval from onset of symptoms to surgery averaged 18 months. Four patients reported a traumatic onset of symptoms, and 4 reported an insidious onset. For all patients, treatment by nonsteroidal anti-inflammatory drugs, splinting, and steroid injection had failed. Routine radiography revealed a loose body in only 4 patients. Trispiral tomography delineated all loose bodies. Three patients underwent loose-body excision only; 5 had PT joint degeneration and underwent additional pisiformectomy. Length of follow-up monitoring averaged 7.4 years. All patients had resolution of wrist pain and improvement in strength. There were no complications. Loose bodies, which may form in the PT joint or migrate from the radiocarpal joint, were identified best by tomography, with simple excision providing excellent relief of symptoms in the absence of PT joint degeneration.