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J Wrist Surg 2023; 12(04): 331-336
DOI: 10.1055/s-0042-1758708
Scientific Article

Patient Satisfaction with Pisiform Excision for Pisotriquetral Instability or Arthritis: A Prospective Review

Mikaela J. Peters 
1   Department of Orthopaedic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
,
Avi Mazor
1   Department of Orthopaedic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
2   Hand Surgery Unit, Department of Orthopaedics, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
,
Zafeiria Glaris
1   Department of Orthopaedic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
,
Thomas Joseph Goetz
1   Department of Orthopaedic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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Abstract

Background Pisotriquetral pain and instability is an elusive cause of ulnar-sided wrist pain. Initial treatment of chronic pisotriquetral pathology should involve a trial of nonoperative therapy such as neutral wrist splint, anti-inflammatories, and intra-articular steroid injections. The mainstay of surgical management of pisotriquetral pain is pisiform excision.

Purpose This prospective study seeks to understand patient satisfaction after pisiform excision in patients with isolated pisotriquetral pathology.

Patients and Methods A consecutive series of nine cases of pisiform excision was performed by the senior surgeon. The primary outcome measure was determined a priori to be the Patient-Rated Wrist Evaluation (PRWE) score. Wrist range of motion, grip strength, and QuickDASH (shortened version of Disabilities of the Arm, Shoulder and Hand) scores were also collected preoperatively and at 3 and 12 months postoperatively as secondary outcome measures.

Results There was a very rapid improvement in the PRWE by 3 months, which was maintained at 12 months. The QuickDASH score was slower to improve, with a significant improvement by 12 months. There was no change in grip strength or wrist range of motion at any time point.

Conclusion Pisiform excision results in a very rapid improvement of symptoms and should be considered in cases of pisotriquetral instability or arthritis that fail conservative management.

Level of Evidence Level IV, case series.

Keywords

patient-reported outcome measures - pisiform arthritis - pisiform excision - pisotriquetral instability

Ethical Review Committee

Ethical approval for this study was obtained from the Providence Health Care Research Ethics Board (H19-02052).


Location

All work was performed at St. Paul's Hospital, 306F Burrard Building, 1081 Burrard St, Vancouver BC V6Z 1Y6.




Publication History

Received: 25 March 2022

Accepted: 27 September 2022

Article published online:
29 December 2022

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