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Os pisiforme – Pisiform Bone: Anatomy and Function

The os pisiforme is a small, pea-shaped bone located in the wrist. It belongs to the proximal carpal row and plays an important role in hand movement and function.

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Things worth knowing about "Os pisiforme"

The os pisiforme is a small, pea-shaped bone located in the wrist. It belongs to the proximal carpal row and plays an important role in hand movement and function.

What is the Os pisiforme?

The os pisiforme (Latin for pea-shaped bone), commonly known as the pisiform bone, is the smallest bone of the carpus (wrist). It belongs to the proximal carpal row and is located on the ulnar side (the side of the little finger) of the wrist. The pisiform is a sesamoid-like bone, embedded within the tendon of the flexor carpi ulnaris muscle, and does not directly participate in the formation of the wrist joint.

Anatomy and Location

The pisiform bone articulates exclusively with the triquetrum (triangular bone), its neighboring carpal bone. It is situated on the palmar (palm-facing) side of the wrist and can be felt as a small bony prominence on the ulnar side of the wrist. Due to its position near the Guyon canal, it has a close anatomical relationship with the ulnar nerve and the ulnar artery.

Function

As an attachment point for the flexor carpi ulnaris muscle, the pisiform acts as a pulley (hypomochlion) that improves the mechanical advantage of the tendon.
It serves as the origin of the abductor digiti minimi muscle (little finger abductor).
It forms the ulnar border of the Guyon canal, protecting the ulnar nerve.

Clinical Relevance

Fractures of the Pisiform

Although rare, pisiform fractures can occur, typically from direct trauma to the wrist (e.g., a fall on an outstretched hand) or from repetitive stress (stress fracture). Symptoms include pain and tenderness on the ulnar side of the wrist.

Pisotriquetral Arthritis

Arthritis of the pisotriquetral joint (between the pisiform and triquetrum) can cause chronic wrist pain. Treatment options range from conservative measures such as physiotherapy and pain medication to surgical removal of the pisiform (pisiformectomy).

Guyon Canal Syndrome

Due to its proximity to the Guyon canal, enlargement, displacement, or fracture of the pisiform can compress the ulnar nerve. This may result in numbness, tingling, or weakness in the little finger and ring finger.

Diagnosis

Conditions involving the pisiform are diagnosed using:

Physical examination: Palpation of the bone for tenderness
X-ray: Standard imaging for suspected fractures
MRI (Magnetic Resonance Imaging): Detailed visualization of soft tissues, bone, and nerves
CT (Computed Tomography): Precise assessment of bony injuries

Treatment

Treatment depends on the specific condition:

Conservative treatment: Immobilization, ice application, anti-inflammatory medications (NSAIDs) for minor injuries
Physiotherapy: Strengthening and mobilization following injury
Surgical treatment: Pisiformectomy (surgical removal) for persistent symptoms due to arthritis or fracture complications

References

Schünke M, Schulte E, Schumacher U. Prometheus - Atlas of Anatomy: General Anatomy and Musculoskeletal System. Thieme Publishers, Stuttgart, 2018.
Calfee RP, Stern PJ. Pisiform Fractures and Pisiform Arthritis. Hand Clinics. 2010;26(4):465-471. PubMed PMID: 20951900.
Gilula LA, Yin Y. Imaging of the Wrist and Hand. W.B. Saunders Company, 1996.

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