PMC6968535_01
(a) Plane X-ray before the surgery (b) 3D reconstruction CT scan before the surgery (c) T2 image of MRI; white arrow indicates pisiform.
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The radiography and computed tomography (CT) of the wrist joint showed an unusual shape of the pisiform as well as an incomplete coalition between the pisiform and hamate (Figure 1(a,b)). T2 fat suppression imaging (Figure 1(c)).
MRI findings revealed that the ulnar nerve (white arrow) run over the hook of hamate.
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The axial view of the wrist joint revealed that the patient's ulnar nerve runs over the hook of the hamate, which should run between the pisiform and hook of the hamate (Figure 2). The injection of an analgesic did not relieve his pain; thus, surgical resection of the pisiform was performed.
(a) X-ray imaging during the surgery; the needle was inserted between pisiform and hamate (b) Interoperative view; ulnar nerve (white arrow) is retracted radial to the coalition (black arrow). The nerve runs over the hook of the hamate. (c) Plane X-ray two years after the surgery.
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There was a fibrous connection between the pisiform and hamate (Figure3(a,b)), and the pisiform was removed in one block. The follow-up radiograph showed normal alignment of the remaining carpal bones (Figure3(c)).