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Pisotriquetral Joint: Assessment with MR Imaging and MR Arthrography¹

¹ From the Department of Radiology, Veterans Administration Medical Center, 3350 La Jolla Village Dr, San Diego, CA 92161 (N.H.T., C.W.A.P., C.B.C., G.E.A., D.J.T., D.R.); and Department of Radiology, CHUV, Lausanne, Switzerland (N.H.T.). Received February 15, 2001; revision requested April 9; final revision received September 10; accepted September 19. Supported by the Swiss Radiological Society and the Swiss National Science Foundation. Address correspondence to D.R. (e-mail: dresnick@ucsd.edu).

View larger version (79K): [in a new window]   Figure 1. Right-hand palmar view of the anatomic structures in the region of the pisiform bone.

View larger version (143K): [in a new window]   Figure 2a. (a) Sagittal T1-weighted spin-echo (500/12) MR arthrogram of the left pisiform bone with the wrist in extended position. The bulk of the fibers of the ulnar flexor tendon (straight arrow) insert on the proximal aspect of the pisiform bone (P). Additional strands extend over the pisiform bone to join the fibers of the pisohamate ligament (curved arrow). The pisohamate ligament extends from the palmar distal aspect of the pisiform bone (insertion type A) to the hook of the hamate bone (H). T = triquetral bone, U = ulna. (b) Coronal T1-weighted spin-echo (500/12) MR image of the pisiform bone (P). The ulnar nerve follows the shape of the left pisiform bone in the Guyon canal (arrowheads). Arrow = ulnar flexor tendon.

View larger version (145K): [in a new window]   Figure 2b. (a) Sagittal T1-weighted spin-echo (500/12) MR arthrogram of the left pisiform bone with the wrist in extended position. The bulk of the fibers of the ulnar flexor tendon (straight arrow) insert on the proximal aspect of the pisiform bone (P). Additional strands extend over the pisiform bone to join the fibers of the pisohamate ligament (curved arrow). The pisohamate ligament extends from the palmar distal aspect of the pisiform bone (insertion type A) to the hook of the hamate bone (H). T = triquetral bone, U = ulna. (b) Coronal T1-weighted spin-echo (500/12) MR image of the pisiform bone (P). The ulnar nerve follows the shape of the left pisiform bone in the Guyon canal (arrowheads). Arrow = ulnar flexor tendon.

View larger version (154K): [in a new window]   Figure 3. Coronal T1-weighted spin-echo (500/12) MR image of the right pisiform bone (P). The pisohamate ligament (straight arrow) extends from the distal aspect of the pisiform bone to the hook of the hamate bone (H). The abductor muscle of the little finger (curved arrows) inserts proximally on the pisiform bone and the pisometacarpal ligament (arrowheads).

View larger version (127K): [in a new window]   Figure 4a. (a) Sagittal T1-weighted spin-echo (500/12) MR arthrogram of the pisiform bone (P) with the right wrist in extended position. The pisometacarpal ligament (arrowheads) extends from the palmar distal aspect of the pisiform bone to the base of the fifth metacarpal (MC5). Curved arrows = short flexor muscle of little finger, straight arrow = ulnar flexor tendon, T = triquetral bone. (b) Sagittal anatomic correlation of the pisiform bone with the right wrist in neutral position. The pisometacarpal ligament (arrowheads) extends from the palmar distal aspect of the pisiform bone (P) to the base of the fifth metacarpal (MC5). Arrow = ulnar flexor tendon, T = triquetral bone. (c) Transverse T1-weighted spin-echo (500/12) MR image of the distal row of the right carpus. The pisometacarpal ligament (arrowheads) courses through the concavity along the ulnar aspect of the hook of the hamate bone (curved arrow).

View larger version (146K): [in a new window]   Figure 4b. (a) Sagittal T1-weighted spin-echo (500/12) MR arthrogram of the pisiform bone (P) with the right wrist in extended position. The pisometacarpal ligament (arrowheads) extends from the palmar distal aspect of the pisiform bone to the base of the fifth metacarpal (MC5). Curved arrows = short flexor muscle of little finger, straight arrow = ulnar flexor tendon, T = triquetral bone. (b) Sagittal anatomic correlation of the pisiform bone with the right wrist in neutral position. The pisometacarpal ligament (arrowheads) extends from the palmar distal aspect of the pisiform bone (P) to the base of the fifth metacarpal (MC5). Arrow = ulnar flexor tendon, T = triquetral bone. (c) Transverse T1-weighted spin-echo (500/12) MR image of the distal row of the right carpus. The pisometacarpal ligament (arrowheads) courses through the concavity along the ulnar aspect of the hook of the hamate bone (curved arrow).

View larger version (144K): [in a new window]   Figure 4c. (a) Sagittal T1-weighted spin-echo (500/12) MR arthrogram of the pisiform bone (P) with the right wrist in extended position. The pisometacarpal ligament (arrowheads) extends from the palmar distal aspect of the pisiform bone to the base of the fifth metacarpal (MC5). Curved arrows = short flexor muscle of little finger, straight arrow = ulnar flexor tendon, T = triquetral bone. (b) Sagittal anatomic correlation of the pisiform bone with the right wrist in neutral position. The pisometacarpal ligament (arrowheads) extends from the palmar distal aspect of the pisiform bone (P) to the base of the fifth metacarpal (MC5). Arrow = ulnar flexor tendon, T = triquetral bone. (c) Transverse T1-weighted spin-echo (500/12) MR image of the distal row of the right carpus. The pisometacarpal ligament (arrowheads) courses through the concavity along the ulnar aspect of the hook of the hamate bone (curved arrow).

View larger version (138K): [in a new window]   Figure 5a. (a) Transverse T1-weighted spin-echo (500/12) MR image of the right wrist. The dorsal carpal ligament (black arrowheads) inserts in the ulnar aspect of the pisiform bone. The fibrous capsule (white arrow) is not well seen. The transverse carpal ligament lies over the carpal tunnel and inserts in the ulnar flexor tendon (black arrow) near the ligamentum carpi palmare (white arrowheads). (b) Transverse T1-weighted spin-echo (500/12) MR arthrogram of the right wrist. The dorsal carpal ligament (black arrowheads) inserts in the ulnar aspect of the pisiform bone. The fibrous capsule (black arrow) is well visualized. The Guyon canal is delimited by the ligamentum carpi palmare (white arrowheads) and the ligamentum flexorum (curved white arrow). The thick white arrow points to the ulnar flexor tendon. Note the focal cartilage defect in the triquetral bone (upper open white arrow) and the global cartilage defect in the pisiform bone (lower open white arrow). (c) Transverse anatomic correlation of the first row of the right wrist. The dorsal carpal ligament (black arrowheads) inserts in the ulnar aspect of the pisiform bone. The fibrous capsule (white arrow) is not well visualized. The transverse carpal ligament lies over the carpal tunnel and inserts on the ulnar flexor tendon (black arrow) near the ligamentum carpi palmare (white arrowheads).

View larger version (128K): [in a new window]   Figure 5b. (a) Transverse T1-weighted spin-echo (500/12) MR image of the right wrist. The dorsal carpal ligament (black arrowheads) inserts in the ulnar aspect of the pisiform bone. The fibrous capsule (white arrow) is not well seen. The transverse carpal ligament lies over the carpal tunnel and inserts in the ulnar flexor tendon (black arrow) near the ligamentum carpi palmare (white arrowheads). (b) Transverse T1-weighted spin-echo (500/12) MR arthrogram of the right wrist. The dorsal carpal ligament (black arrowheads) inserts in the ulnar aspect of the pisiform bone. The fibrous capsule (black arrow) is well visualized. The Guyon canal is delimited by the ligamentum carpi palmare (white arrowheads) and the ligamentum flexorum (curved white arrow). The thick white arrow points to the ulnar flexor tendon. Note the focal cartilage defect in the triquetral bone (upper open white arrow) and the global cartilage defect in the pisiform bone (lower open white arrow). (c) Transverse anatomic correlation of the first row of the right wrist. The dorsal carpal ligament (black arrowheads) inserts in the ulnar aspect of the pisiform bone. The fibrous capsule (white arrow) is not well visualized. The transverse carpal ligament lies over the carpal tunnel and inserts on the ulnar flexor tendon (black arrow) near the ligamentum carpi palmare (white arrowheads).

View larger version (139K): [in a new window]   Figure 5c. (a) Transverse T1-weighted spin-echo (500/12) MR image of the right wrist. The dorsal carpal ligament (black arrowheads) inserts in the ulnar aspect of the pisiform bone. The fibrous capsule (white arrow) is not well seen. The transverse carpal ligament lies over the carpal tunnel and inserts in the ulnar flexor tendon (black arrow) near the ligamentum carpi palmare (white arrowheads). (b) Transverse T1-weighted spin-echo (500/12) MR arthrogram of the right wrist. The dorsal carpal ligament (black arrowheads) inserts in the ulnar aspect of the pisiform bone. The fibrous capsule (black arrow) is well visualized. The Guyon canal is delimited by the ligamentum carpi palmare (white arrowheads) and the ligamentum flexorum (curved white arrow). The thick white arrow points to the ulnar flexor tendon. Note the focal cartilage defect in the triquetral bone (upper open white arrow) and the global cartilage defect in the pisiform bone (lower open white arrow). (c) Transverse anatomic correlation of the first row of the right wrist. The dorsal carpal ligament (black arrowheads) inserts in the ulnar aspect of the pisiform bone. The fibrous capsule (white arrow) is not well visualized. The transverse carpal ligament lies over the carpal tunnel and inserts on the ulnar flexor tendon (black arrow) near the ligamentum carpi palmare (white arrowheads).

View larger version (130K): [in a new window]   Figure 6. Sagittal T1-weighted spin-echo (500/12) MR arthrogram of the pisiform bone with the left wrist in flexed position. Much of the cartilage of the pisiform bone (black arrow) is absent. Note the movement of the midpoints (arrows) of the articular surfaces (arrowheads) of the pisiform bone and the triquetral bone (T). H = hamate bone, MC = fifth metacarpal, U = ulna.

View larger version (133K): [in a new window]   Figure 7. Sagittal T1-weighted spin-echo (500/12) MR arthrogram of the pisiform bone with the left wrist in neutral position. Note the round shape of the proximal recess of the PTJ (arrowheads) compared with the small and flat shape of the distal recess (small black arrows). Curved arrow = pisometacarpal ligament, large black arrow = ulnar flexor tendon, H = hamate bone, MC = fifth metacarpal, P = pisiform bone, T = triquetral bone.