PisoTriquetral (PT) Tenderness

Test, Exam and Signs


  • Pisotriquetral (PT) tenderness is related to the pisiform, a carpal sesamoid bone that lies within the flexor carpi ulnaris (FCU) tendon.1 The pisiform holds the triquetrum in position and prevents its subluxation, even in extreme extension. It functions as a fulcrum while transducing strong forearm forces to the hand.2


  • PT tenderness may be caused by PT arthritis or posttraumatic arthritis. 
  • Chronic causes of PT tenderness include osteoarthritis, pisotriquetral joint (PTJ) arthrosis or tendinopathy.3


  1. Record the patient’s history, including any sports-related injuries. Ask the patient to rate how much pain s/he usually experiences in the affected wrist on a scale from 1 to 10
  2. Check for tenderness, crepitus and pain
  3. Palpate the PT joint by hyperextension loading and radioulnar translation of the pisiform on the triquetrum3
  4. Examine the contralateral wrist for comparison


  • Consider neurological symptoms, including paresthesias4

Related Signs and Tests

  • Pisiform shear test 1
  • FCU tenderness
  • triangular fibrocartilage complex (TFCC) tenderness
  • Wrist range of motion (ROM)
  • Neurovascular exam
  • Arthroscopy

Diagnostic Performance Characteristics

  • Do not use other patients’ reactions as a comparison, because other patients may have different perceptions of similar tenderness and/or pain
Presentation Photos and Related Diagrams
Pisotriquetral Examination
  • Examine the pisiform triquetral joint for tenderness.  FCU (flexor carpi ulnaris)
    Examining the pisiform triquetral joint for tenderness. FCU (flexor carpi ulnaris)
Definition of Positive Result
  • A positive result occurs when pressure applied to the PT joint causes increased tenderness. 
Definition of Negative Result
  • A negative result occurs when pressure applied to the PT joint does not cause increased tenderness. 
Comments and Pearls
  • Pisiform excision may relieve pain and help preserve wrist motion and strength.4 
  • In patients who place the wrist in maximal extension, such as gymnasts, it may be best to avoid excision. For treating PT injuries, pisotriquetral arthrodesis may be a useful alternative to excision. 3
Diagnoses Associated with Tests, Exams and Signs
  1. Culp R, Jacoby S. Musculoskeletal Examination of the Elbow, Wrist and Hand: Making the Complex Simple. New Jersey: SLACK Incorporated, 2012.
  2. Beckers A, Koebke J. Mechanical strain at the pisotriquetral joint. Clin Anat 1998;11(5):320-6. PMID: 9725576
  3. Abrams R, Tontz W. Pisotriquetral Arthrodesis as an Alternative to Excision for Pisotriquetral Instability in High-Demand Patients: A Case Report in a Gymnast. J Hand Surg 2006;31A:611-4. PMID: 16632056
  4. Campion H, Goad A, Rayan G et al. Pisiform Excision for Pisotriquetral Instability and Arthritis. J Hand Surg Am 2014;39(7):1251-7. PMID: 24855969