Abstract
Background Pisiform excision and pisotriquetral arthrodesis are two surgical options for the
treatment of pisotriquetral joint pain when conservative methods fail. However, it
is unclear which option is best for patients who experience substantial, repetitive
loading on their wrists and wish to preserve wrist flexibility and function.
Case Description We present a case of bilateral ulnar-sided wrist pain related to the pisotriquetral
joint in a 19-year-old collegiate diver. The pain was exacerbated by activities specific
to this sport that requires wrist hyperextension, namely full weight-bearing on the
hands (handstands), and has an impact on the hands and wrists upon water entry during
dives due to direct palmar pressure. There were no radiographic signs of arthritis;
however, there were bone marrow changes on magnetic resonance imaging (MRI). Management
with rest, splinting, and corticosteroid injection failed to relieve the pain and
precluded his ability to return to full-time diving. Treatment consisted of bilateral
pisiform excision. Postoperatively, the patient returned to full-time competitive
diving with resolution of his painful symptoms.
Literature Review Pisiform excision has been shown to have successful outcomes in terms of return to
play for lower impact athletes (such as badminton) but has not been reported in athletes
who experience a high degree of force repetitively (such as gymnasts or divers). There
is one report of pisotriquetral arthrodesis in a young gymnast with suboptimal results.
Clinical Relevance This case report demonstrates that pisiform excision is a successful treatment for
elite athletes who experience repetitive, palmar force on hyperextended wrists and
subsequently develop ulnar-sided wrist pain.
Keywords
pisiform excision - pisotriquetral joint - athlete - ulnar wrist pain
