From the Guidelines
Pisiform bone pain can be effectively managed with a combination of rest, anti-inflammatory medications, and supportive measures, prioritizing the reduction of morbidity, mortality, and improvement of quality of life. For immediate relief, taking over-the-counter NSAIDs like ibuprofen (400-600mg every 6-8 hours) or naproxen (220-440mg twice daily) for 7-10 days can reduce inflammation and pain, as supported by the EULAR evidence-based recommendations for the management of hand osteoarthritis 1. Applying ice to the affected area for 15-20 minutes several times daily, especially after activities that aggravate the pain, can also help alleviate symptoms.
Key Considerations
- A wrist brace or splint that immobilizes the pisiform area while allowing finger movement can provide support during healing.
- Gentle stretching and strengthening exercises for the wrist can be started once acute pain subsides.
- The pisiform is a small, pea-shaped bone in the wrist that articulates with the triquetrum bone, and pain typically results from osteoarthritis, trauma, or repetitive stress.
- If pain persists beyond 2-3 weeks despite these measures, or if there's significant swelling or limited motion, consulting a healthcare provider is necessary to consider corticosteroid injections or, rarely, surgical intervention, as suggested by the EULAR recommendations for the management of hand osteoarthritis 1.
Management Approach
- Rest and anti-inflammatory medications are the first line of treatment, aiming to reduce pain and inflammation.
- Supportive measures, such as wrist braces or splints, can provide additional relief and support during the healing process.
- Gentle exercises can help maintain wrist mobility and strength, reducing the risk of further injury or complications.
- Monitoring and follow-up are crucial to assess the effectiveness of the treatment plan and adjust it as necessary to ensure the best possible outcome in terms of morbidity, mortality, and quality of life.
From the Research
Pisiform Bone Pain Treatment Options
- Pisiform excision is a surgical option for treating pisotriquetral joint pain when conservative methods fail, as seen in studies 2, 3, 4, 5.
- This procedure has been shown to have successful outcomes in terms of return to play for lower impact athletes, as well as elite athletes who experience repetitive, palmar force on hyperextended wrists 2.
- Pisiform excision can be performed using an open or arthroscopic approach, with the arthroscopic technique being a novel and minimally invasive option 4.
- The procedure involves removing the pisiform bone while preserving the insertion of the flexor carpi ulnaris tendon and its distal extension, the piso hamate and the piso metacarpal ligaments 3.
Indications for Pisiform Excision
- Painful union or nonunion of pisiform fractures
- Pisiform-triquetrial arthritis
- Tendonitis of the flexor carpi ulnaris (FCU) insertion 3
- Ulnar-sided wrist pain related to the pisotriquetral joint, especially in athletes who experience repetitive, palmar force on hyperextended wrists 2
Alternative Treatment Options
- Ultrasound-guided injection of the pisotriquetral joint can be used to relieve symptoms, with some patients experiencing immediate relief 6.
- Conservative methods such as rest, splinting, and corticosteroid injection can be tried before considering surgical options 2, 5.
- Arthroscopic debridement of the pisotriquetral joint is another surgical option, although it is less commonly used 6.