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

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


  • 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


  • 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.


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