J Korean Soc Surg Hand.  2013 Sep;18(3):132-137. 10.12790/jkssh.2013.18.3.132.

Surgical Management of Pisiform Bone Deformity Associated with Tendonitis of Flexor Carpi Ulnaris

• Kwon SM
• Cha JH
• Oh JR

• KMID: 2194143
• DOI: http://doi.org/10.12790/jkssh.2013.18.3.132

Abstract

PURPOSE
This study was performed to investigate the degree of symptom improvement after removal of bone fragment in patients with deformed pisiform bone associated with tendonitis of flexor carpi ulnaris.
METHODS
Pisiform bone fragment removal was performed in 12 patients who had failed conservative treatment from January 2008 to December 2011. They were followed up at 2 weeks, 1 month, 2 months, 6 months, and 12 months after surgery. Their symptoms were assessed with Green score.
RESULTS
Eleven of 12 patients who underwent bone fragment removal showed symptom improvement. Symptoms worsened in 1 patient due to pain and restricted range of motion caused by postoperative scar.
CONCLUSION
The results of this study suggest that removal of bone fragment may be an effective treatment in patients with tendonitis of flexor carpi ulnaris accompanied by pisiform bone deformity whose pain does not improve with conservative management.

Keyword

Flexor carpi ulnaris; Pisiform bone; Surgical management; Wrist pain; Bone widening

MeSH Terms

Congenital Abnormalities
Humans
Pisiform Bone
Range of Motion, Articular
Tendinopathy
Tendons

Figure

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  Fig. 1. Bone widening of the pisiform bone in carpal tunnel X-ray view of the patient with tendonitis of flexor carpi ulnaris caused by repeated movement and inflammation.

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  Fig. 2. Radiograph and ultrasonograph of the patient with tendonitis of flexor carpi ulnaris. (A) Bone widening of the pisiform bone can be observed on radiograph. (B) Ultrasonograph also shows calcified tissues between the pisiform bone and flexor carpi ulnaris (FCU).

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  Fig. 3. Surgical technique on bone widening due to inflammation of the flexor carpi ulnaris. (A) The pisiform bone at the ulnar side of the palm was checked through palpation. (B) A V-shaped skin incision was made at the ulnar side to confirm the location of the pisiform bone. (C) The skin was retracted to obtain operative window, and the flexor carpi ulnaris was found after dissection of the soft tissue and the fascia. (D) The flexor carpi ulnaris was retract towards the radial side to expose the pisiform bone.

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  Fig. 4. Surgical technique on bone widening due to inflammation of the flexor carpi ulnaris. (A) The hypertrophied portion of the pisiform bone found after radial retraction of the flexor carpis ulnaris is marked and is resected. (D) Bone fragment after removal. (C) Carpal tunnel X-ray after bone fragment removal. (D) Bone fragments observed preoperative are not present.

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