Pisotriquetral joint osteoarthritis and instability: A narrative review of anatomy, diagnosis, and management

The pisotriquetral (PT) joint is a small synovial compartment often overlooked as a source of ulnar-sided wrist pain, frequently leading to diagnostic delays. This review updates current knowledge on PT osteoarthritis (OA), providing clinical pearls for diagnosis and a summary of therapeutic options. A comprehensive search was performed across PubMed, Scopus, and Google Scholar to identify relevant literature concerning pisotriquetral (PT) joint pathology. The review synthesized data from cadaveric studies, clinical series, and anatomical reviews, focusing on the diagnosis, biomechanics, and therapeutic management of pisotriquetral osteoarthritis and instability. PT pathology is highly prevalent in the elderly, with macroscopic OA signs found in 100% of cadaveric donors over 65. Causes are multifactorial, ranging from age-related primary degeneration to secondary factors like acute trauma or repetitive mechanical stress, particularly in athletes. Patients typically report chronic pain at the hypothenar eminence, exacerbated by gripping or twisting. The "pisotriquetral grind test" is the most reliable physical examination maneuver. While standard radiographs are often inconclusive, a 30° semi-supinated oblique view is the gold standard for visualizing joint narrowing and osteophytes. Diagnostic intra-articular injections provide definitive confirmation. Initial treatment is conservative, including splinting, activity modification, and corticosteroid injections. If symptoms persist for 3–6 months, pisiformectomy is the therapeutic "gold standard," offering significant long-term pain relief and functional recovery without compromising wrist stability. Including the PT joint in the differential diagnosis of ulnar wrist pain is essential for ensuring a favorable prognosis and a swift return to daily activities.