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Journal of Radiology Case Reports Apr 2022The pisiform is a sesamoid bone that acts as one of the key medial stabilizers of the wrist. We present a case of a 35-year-old gentleman who presented with medial wrist...
The pisiform is a sesamoid bone that acts as one of the key medial stabilizers of the wrist. We present a case of a 35-year-old gentleman who presented with medial wrist pain following a fall while rollerblading. Radiographs and Magnetic resonance imaging (MRI) revealed a rare combination of an acute pisiform dislocation with associated triquetral fracture. Subsequently, he was successfully treated with excision of the pisiform. Pisiform dislocation is an uncommon injury and can easily be missed in an acute emergency presentation. Therefore, it is important to be aware of the characteristic imaging appearance to avoid a delay in diagnosis and treatment.
Topics: Accidental Falls; Adult; Humans; Joint Dislocations; Male; Pisiform Bone; Radiography; Wrist Joint
PubMed: 35530418
DOI: 10.3941/jrcr.v16i4.4474 -
Median Nerve Recovery and Morphological Change on MRI at 24 Months after Open Carpal Tunnel Release.The Journal of Hand Surgery... Apr 2023This study aimed to investigate the relationship between postoperative clinical results and long-term morphological changes in patients with carpal tunnel syndrome...
This study aimed to investigate the relationship between postoperative clinical results and long-term morphological changes in patients with carpal tunnel syndrome (CTS) as observed on magnetic resonance imaging (MRI) before and after open carpal tunnel release (OCTR). We retrospectively analysed data for 28 hands that had undergone OCTR with at least 24 months of follow-up data. Two-point discrimination (2PD) test results were examined for the first three fingers, as were the distal motor latency (DML) and sensory conduction velocity (SCV) of the median nerve. We also calculated the cross-sectional area (CSA) of the carpal tunnel and the distance from the median nerve to the volar carpal bone at the hamate and the pisiform levels using MRI images. Variables were compared before and 24 months after OCTR. Significant improvements in all variables were observed, including average 2PD scores (Finger I: 13.1 ± 6.2 vs. 7.7 ± 4.3, < 0.01, Finger II: 11.9 ± 6.6 vs. 7.0 ± 3.5, < 0.01, Finger III: 13.6 ± 6.1 vs. 7.8 ± 4.5, < 0.01), average DML (8.3 ± 3.3 vs. 4.3 ± 0.6 m/s, < 0.01), average SCV (30.8 ± 11.0 vs. 41.3 ± 5.3 m/s, < 0.01), CSA of the carpal tunnel (hamate level: 194.9 ± 30.6 vs. 254.2 ± 47.6 mm, < 0.01, pisiform level: 244.2 ± 46.5 vs. 274.7 ± 75.1 mm, = 0.01) and the distance between the median nerve and volar carpal bone (hamate level: 8.7 ± 1.4 vs. 11.2 ± 1.6 mm, < 0.01, pisiform level: 11.8 ± 1.7 vs. 13.8 ± 2.5 mm, < 0.01). Our results demonstrate that OCTR is successful in achieving long-term decompression and recovery of the median nerve in patients with CTS. Level III (Therapeutic).
Topics: Humans; Carpal Tunnel Syndrome; Magnetic Resonance Imaging; Median Nerve; Retrospective Studies; Wrist
PubMed: 37120302
DOI: 10.1142/S2424835523500212 -
Hand (New York, N.Y.) Oct 2023Flexor tendon entrapments as a result of fractures or dislocations in the upper extremity are rare. Diagnosis by clinical examination is not always possible, and imaging...
Flexor tendon entrapments as a result of fractures or dislocations in the upper extremity are rare. Diagnosis by clinical examination is not always possible, and imaging such as magnetic resonance imaging and ultrasound is often obtained. These modalities have the disadvantages of reduced sensitivity or increased cost and time, respectively. We present a unique case of a triquetral fracture and pisiform dislocation causing index finger flexor digitorum profundus (FDP-I) entrapment that was diagnosed preoperatively with computed tomography (CT) imaging with 3-dimensional (3D) volume rendering. A 30-year-old man presented in delayed fashion 4 weeks after a dune buggy accident. Among other injuries noted on examination, his index finger was held in flexion and unable to be passively extended. The CT source images showed dislocation and interposition of the FDP-I tendon within a fracture-dislocation of the triquetrum and pisiform. Postprocessed 3D volume renderings obtained from the CT source images confirmed this finding. The patient underwent operative intervention, where FDP-I entrapment between the triquetral fracture fragments and the dislocated pisiform was confirmed and released. Practitioners should be aware of this injury pattern and evolving advanced CT techniques which may be used to aid in soft-tissue diagnoses and obviate the need for additional advanced imaging.
Topics: Male; Humans; Adult; Trigger Finger Disorder; Fractures, Bone; Fracture Dislocation; Tendons; Joint Dislocations; Tomography, X-Ray Computed
PubMed: 37489114
DOI: 10.1177/15589447231185857 -
Journal of Orthopaedic Case Reports Sep 2020Chondroblastoma is a rare primary benign tumor of bone with male predominance and is typically seen in an epiphyseal location. The pisiform is a carpal bone and...
INTRODUCTION
Chondroblastoma is a rare primary benign tumor of bone with male predominance and is typically seen in an epiphyseal location. The pisiform is a carpal bone and chondroblastoma of the pisiform has not been reported in the literature to the best of our knowledge.
CASE PRESENTATION
An 18-year-old male presented with painful swelling over his right wrist with restriction of ulnar deviation. Based on magnetic resonance imaging findings, two diagnostic possibilities were entertained, namely, giant cell tumor of bone and chondroblastoma. Wide local excision was performed, and histopathology confirmed the diagnosis of chondroblastoma of the pisiform. After 2 years of follow-up, the patient has gained pain-free wrist movements post excision, and there are no signs of recurrence. The Modified Mayo Wrist Score of 75 (fair) improved to 100 (excellent).
CONCLUSION
Surgeon should always keep in mind the possibility of the tumor at the rare site and accurately diagnose the tumor with the help of imaging modalities and biopsy.
PubMed: 33489960
DOI: 10.13107/jocr.2020.v10.i06.1854 -
Forensic Science International Aug 2020Current multifactorial age estimation methods are based on radiography, however, in the forensic field there is growing interest in using magnetic resonance imaging...
Current multifactorial age estimation methods are based on radiography, however, in the forensic field there is growing interest in using magnetic resonance imaging (MRI). With regard to the carpal region, MRI provides more information for defining the individual ossification nuclei and the cartilage surrounding single bones. During the phase of bone growth, the progressive reduction of the cartilage layer is accompanied by the development of a cartilage-bone interface. The aim of our study was to create a new model for age estimation, based on the ratio between the area occupied by the nucleus of ossification (NO) and the surface of growth (SG) of each carpal bone, the latter derived by adding NO to the area of cartilage-bone interface. We analyzed 57 MRI scans of Italian subjects aged between 12 and 20 years, without growth diseases, endocrine disorders or osteodystrophy. Measurements of NO and SG areas were extracted using ImageJ software, and the ratio between the NO and SG of each bone (NOSG) was calculated. A multiple linear regression model was used to estimate the individual's age as a function of the variables: gender and wrist bone measurements. The results showed that the best model was obtained with 6 predictors (nvmax=6): Gender, and the NOSG of the Trapezoid, Trapezium, Scaphoid, Pisiform, and Capitate. The median of the residuals (observed age minus predicted age) was -0.025 years, with an IQR of 0.19 years. Thus a new forensic approach to age assessment using MRI is introduced in this paper, which gives the preliminary results.
Topics: Adolescent; Age Determination by Skeleton; Carpal Bones; Child; Female; Forensic Anthropology; Humans; Image Processing, Computer-Assisted; Linear Models; Magnetic Resonance Imaging; Male; Osteogenesis; Young Adult
PubMed: 32473482
DOI: 10.1016/j.forsciint.2020.110341 -
Anatomical Record (Hoboken, N.J. : 2007) Jun 2023The role of mechanical stimuli in promoting endochondral ossification during somatic growth and maturation remains an active area of research. This study employs a...
The role of mechanical stimuli in promoting endochondral ossification during somatic growth and maturation remains an active area of research. This study employs a pisiform model of endochondral ossification to investigate the potential role of mechanobiological signals in the appearance and development of ossification centers and to develop theoretical applications to the primate basicranium. We constructed finite element models based on the structure of a human pisiform within the flexor carpi ulnaris tendon. The pisiform was assigned initial material properties of hyaline cartilage, and tendon properties were based on in situ observations drawn from the literature. A macaque growth model was used to simulate increased load over time as a function of body mass. A load case of uniaxial tension from the tendon was applied over 208 iterations, to simulate weekly growth over a 4-year span. The mechanical signal was defined as shear stress. Element stresses were evaluated in each iteration, with elements exceeding the yield threshold subsequently assigned a higher elastic modulus to mimic mechanically driven mineralization. Three unique mineralization rates were tested. Regardless of rate, all ossification simulations predict a pisiform with heterogeneous stiffness through alternating periods of material stasis and active mineralization/ossification. Assuming metabolic processes underlying endochondral ossification are similar throughout the body, our model suggests that a mechanical signal alone is an insufficient stimulus in the etiology of bone formation through endochondral ossification. Consequently, given the general validity of the simulation, endochondral ossification cannot be fully explained in terms of mechanical stimuli.
PubMed: 37283209
DOI: 10.1002/ar.25274 -
Techniques in Hand & Upper Extremity... Mar 2021Pisotriquetral (PT) joint arthritis is a common cause of ulnar-sided wrist pain. Open pisiform excision is a well-established procedure and is indicated when the...
Pisotriquetral (PT) joint arthritis is a common cause of ulnar-sided wrist pain. Open pisiform excision is a well-established procedure and is indicated when the conservative treatment fails. Although arthroscopic visualization of the PT joint is part of the routine examination in a patient with ulnar-sided wrist pain, therapeutic arthroscopy of the PT joint is limited to one case in the literature through the standard dorsal portals. Arthroscopic pisiform excision is a novel technique described by the authors. The first aim of this procedure is pain relief maintaining wrist stability and strength. With this minimally invasive approach we believe that preserving the flexor carpi ulnaris and the PT ligament complex we maintain their biomechanical function, while at the same time, reducing scar tenderness and postoperative discomfort with better esthetic results and less recovery time. In addition to standard dorsal portals, a direct PT portal was used to have access to the PT space and as a working portal to complete the pisiform excision.
Topics: Arthralgia; Arthroscopy; Carpal Joints; Humans; Osteoarthritis; Pisiform Bone; Wrist Joint
PubMed: 33782357
DOI: 10.1097/BTH.0000000000000345 -
Hand (New York, N.Y.) Apr 2024Clinically recognizing the changes in carpal bone volumes and understanding their implications in predicting osteoarthritis (OA) is crucial in clinical practice This...
BACKGROUND
Clinically recognizing the changes in carpal bone volumes and understanding their implications in predicting osteoarthritis (OA) is crucial in clinical practice This study aimed to explore age-related differences in carpal bone volumes across genders, leveraging computed tomography (CT) wrist scans to create 3D surface models of these bones.
METHODS
Carpal bone volumes were calculated using the 3D Slicer software from CT scans obtained from Frankston Hospital and additional datasets from Brown and Auckland Universities. The data were statistically processed using Stata V13. Double-sided -values < .05 were considered statistically significant. The study was conducted in accordance with the ethical standards laid out in the Declaration of Helsinki.
RESULTS
A total of 181 patients were analyzed, and 48% of whom were female. A statistically significant positive Spearman correlation (rho = 0.37-0.611, <.05) was observed between increasing age and the volume of all surveyed carpal bones (scaphoid, lunate, triquetrum, pisiform, hamate, capitate, and trapezium) across genders. Intrauser and interuser reliabilities for 3D Slicer-generated volumes of trapezium and pisiform bones were statistically significant, with Interclass Correlation Coefficient (ICC) values of 0.86 and 0.95, respectively.
CONCLUSION
Trapezial volumes increase with age, potentially due to the presence of OA and consequent osteophyte formation. This pattern is more prevalent among older individuals and women. However, the positive correlation between carpal bone volume and age was consistent across all carpal bones and both genders, regardless of OA presence. These findings suggest that carpal bone volume may naturally increase with age, independent of OA-related changes.
LEVEL OF EVIDENCE
III, cohort study.
PubMed: 38606949
DOI: 10.1177/15589447241242830 -
BMC Musculoskeletal Disorders Apr 2020Osteochondroma is a benign tumor that occurs mainly at the metaphysis of long bones and seldom arises from carpal bones. We describe an extremely rare case of... (Review)
Review
BACKGROUND
Osteochondroma is a benign tumor that occurs mainly at the metaphysis of long bones and seldom arises from carpal bones. We describe an extremely rare case of osteochondroma of the hamate without a typical cartilaginous cap and with a spiky bony protrusion in an elderly patient.
CASE PRESENTATION
A 78-year-old right-handed female housekeeper had a multilobed osteochondroma of the hamate, which caused carpal tunnel syndrome and irritation of the flexor tendons. Radiological examinations showed a morphological abnormality of the hamate comprising a spiky bony protrusion into the carpal tunnel and a free body proximal to the pisiform. Open carpal tunnel release and resection of the spiky bony protrusion on the hook of the hamate were performed. The flexor digitorum profundus tendons of the ring and little fingers displayed synovitis and partial laceration in the carpal tunnel. Histological examination also showed atypical findings: only a few regions of cartilaginous tissue were seen in the spiky bony protrusion, whereas the free body proximal to the pisiform contained thick cartilaginous tissue such as a cartilaginous cap typical of osteochondroma. We speculated that the bony protrusion to the carpal tunnel had been eroded by mechanical irritation caused by gliding of the flexor tendon and had resulted in the protruding spiky shape with less cartilaginous tissue. The fractured cartilaginous cap had moved into the cavity within the carpal tunnel proximal to the pisiform and had become a large free body.
CONCLUSIONS
Osteochondroma of the carpal bone may take various shapes because the carpal bone is surrounded by neighboring bones and tight ligaments, which can restrict tumor growth. This type of tumor is likely to present with various symptoms because of the close proximity of important structures including nerves, tendons, and joints. The diagnosis of osteochondroma of the carpal bone may be difficult because of its rarity and atypical radiological and histological findings, such as the lack of a round cartilaginous cap. We suggest that surgeons should have a detailed understanding of this condition and should make a definitive diagnosis based on the overall findings.
Topics: Aged; Carpal Tunnel Syndrome; Female; Hamate Bone; Humans; Osteochondroma; Radiography; Tendons; Wrist
PubMed: 32284050
DOI: 10.1186/s12891-020-03272-8