Nonspecific pain in the Little Finger Hypothenar Eminence Hand – Pisiform Instability

Pisiform instability can cause nondescript pain over lateral hand eminence, and in some cases present with ulnar nerve damage. It is little recognized.

J Hand Surg Am. 2018 Jan;43(1):54-60.
doi: 10.1016/j.jhsa.2017.10.020.
Management of Pisotriquetral Instability.
Shulman BS et al
https://www.ncbi.nlm.nih.gov/pubmed/29169722

  • Hypothenar eminence nonspecific pain.
  • feelings of clicking or locking, especially during active
    wrist motion.
  • pain with direct pressure like weight lifting

Testing:

  • pisiform ballottement or shuck test. – move pisiform from side to side and see if hurts (do with wrist flexed and relaxed)

Xrays -semisupination view –  wrist in 30 degrees supination

Treatment

  • Immobilization- short-arm cast or removable wrist brace
    for 4 to 6 weeks
  • NSAID’s
  • steroid injection
  • above works 1/3 of time
  • I would add prolotherapy as a given for instability treatment
  • surgery involves removal- Pisiformectomy with 75-93% pain free following

Comment – another condition I will know now if I see.

 

 

This entry was posted in hand. Bookmark the permalink.

One Response to Nonspecific pain in the Little Finger Hypothenar Eminence Hand – Pisiform Instability

  1. likuoo says:

    Sagittal T1-weighted and T2-weighted MRI scans ( A and B, respectively) clarify the diagnosis of the case depicted in Figure 3, because they reveal a joint between the ossicle and the talus, consistent with os trigonum. In addition to the joint, note the bone edema, which is suggestive of inflammatory changes.

Leave a Reply

Your email address will not be published.