Management of Ulnar Nerve Irritation by Pisiformectomy: A Clinical Anatomical Study.

PURPOSE: The goal of this anatomical clinical study is to clarify whether a simple pisiformectomy can provide sufficient decompression of the ulnar nerve along its entire course within the ulnar canal. METHODS: A simple pisiformectomy was performed in 20 cadaveric hands, followed by complete release of the ulnar nerve. The anatomical findings were subsequently correlated with clinical outcomes in 17 patients presenting with ulnar nerve irritation and pisotriquetral joint pain. RESULTS: Our anatomical results demonstrated that additional division of fibrous structures was not necessary in any specimen. At 12-month follow-up, clinical evaluation revealed a median improvement of 40.6 points in the Quick Disabilities of Arm, Shoulder & Hand score, whereas the visual analog scale improved by a median of 5 points. CONCLUSIONS: In patients with concomitant irritation of the pisotriquetral joint and compression of the ulnar nerve within the ulnar canal, pisiformectomy represents an effective treatment option addressing both conditions simultaneously. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic IIB.