Pisiform excision is an effective and safe treatment for ulnar-sided wrist pain related to the pisotriquetral joint

  • M. V. van BurinkEmail author
  • S. Al Shaer
  • J. van Rossen
  • G. van Couwelaar
  • H. Rakhorst
  • O. T. ZöphelEmail author
Original Paper



Pisotriquetral disorders can cause chronic ulnar-sided wrist pain. When conservative treatment is insufficient, pisiform excision can be a solution. There are reports found in the literature describing variable effects of this procedure in small, descriptive case series.


This study included 175 patients who underwent pisiform excision performed in various specialized private hand clinics between 2011 and 2015. Patients were analyzed using standardized outcome measurements.


Functionality was improved significantly 3 months postoperative, with a decrease in pain (n = 86) (P < 0.05), mean improvement of 13 degrees in wrist flexion/extension (n = 72) (P < 0.001), and 18% increase in strength (n = 75) (P < 0.001). Twelve months postoperatively, the wrist function (PRWHE-DLV) improved from a mean of 64 to 25 (n = 62) (P < 0.001).


The results support pisiform excision as an effective and safe treatment. Significant pain relief can be expected with improvement in wrist function. Unfortunately, a high amount of data was missing. The authors believe that the data presented in the study represents an underestimation of the results.

Level of evidence: Level III, therapeutic study.


Pisiform excision Pisiform bone Wrist pain Pisotriquetral joint osteoarthritis Flexor carpi ulnaris tendinitis Ulnar neuropathy 



Hand-Wrist Study Group2, R Feitz, A Fink, TM Moojen, H Slijper, HL de Boer, J Debeij, N de Haas, G Vermeulen, X Smit, S Souer, E Walbeehm

Statistical analysis: M Brusse-Keizer

Compliance with ethical standards

Patient consent

Patients provided a written consent for the use of their data.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The Medical Ethical Review Committee Twente (Post Office Box 50000, 7500 KA Enschede, The Netherlands; email: approved this study (reference: K16-21) and the data collection was compliant with the principles of the Declaration of Helsinki.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Plastic, Reconstructive and Hand SurgeryZiekenhuisgroep TwenteHengeloThe Netherlands
  2. 2.Xpert ClinicHilversumThe Netherlands
  3. 3.Xpert ClinicEnschedeThe Netherlands

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