Eur J Plast Surg (2004) 27:37–38
J. Dujardin · L. De Smet
Synovial chondromatosis of the pisotriquetral joint
producing ulnar nerve palsy
Received: 11 September 2003 / Accepted: 19 January 2004 / Published online: 13 March 2004
Abstract A case of synovial chondromatosis compressing
the motor branch of the ulnar nerve of the left hand is
presented. Radiographs demonstrated soft tissue calcifica-
tion. The electrophysiological study confirmed dener-
vation of the intrinsic hand muscles. During surgical
exploration, synovial chondromatosis arising from the
pisotriquetral joint compressing on the motor branch of the
ulnar nerve was seen. Treatment consisted of pisiformec-
tomy, partial synovectomy and removal of loose bodies.
Keywords Ulnar nerve · Chondromatosis · Nerve
compression · Wrist · Pisiform bone
Compression of the ulnar nerve at the wrist is extremely
rare compared to the median nerve. Compression syn-
drome of the ulnar nerve can be divided into three groups:
pure motor, pure sensory and mixed. In most cases of
ulnar nerve compression there are identifiable causes,
which is not the case in carpal tunnel compression. The
most common causes are ganglions, followed by trauma,
repetitive use, and anomalous muscles [1, 3, 5, 8]. A
cause that has not yet been described, as far as we could
determine, is presented.
A 50-year-old female patient, in general good health, presented with
swelling at the radial border of the left wrist, and severe weakness of
the left hand. The weakness of her left hand progressed slowly in the
past 2 years. There was no history of trauma of other disorders.
On examination the swelling felt like a ganglion cyst. Range of
movement of the left wrist, fingers and thumb was normal. There
was however obvious atrophy of the adductor pollicis and inter-
osseous muscles (Fig. 1), and mild clawing of the fingers of the left
hand. The Froment sign and Wartenberg sign were positive. There
was tenderness at the pisotriquetral joint and the pisiform with a
6 mm two-point discrimination test of all the fingertips. Sensibility
was normal and symmetrical in both hands. Allen test did not reveal
abnormality in the ulnar and radial arteries.
A plain X-ray showed cystic changes in the pisiform and
calcification at the base of the fifth metacarpal bone (Fig. 2a).
Ultrasound examination confirmed a ganglion on the radial side of
the wrist and synovitis of the pisotriquetral joint with multiple
structures included (Fig. 2b). An electrophysiology study revealed
denervation of the interosseous muscles and adductor pollicis.
Exploration of Guyon’s canal at the wrist was carried out. A
large chondromatous structure protruding from the pisotriquetral
joint (Fig. 3) was identified as it compressed on the motor branch of
the left ulna nerve. The sensory branch was intact. Pisiformectomy
was performed, along with removal of several large loose bodies
and the affected synovium. The pisohamate ligament was divided.
The histology report on the resected specimen described cell-
rich cartilaginous nodules with clusters of chondrocytes bordered
by a fibrous envelope consistent with synovial chondromatosis.
Synovial chondromatosis is a rare condition that has been
mainly described in the knee, hip and elbow. Synovial
J. Dujardin · L. De Smet (
Department of Orthopedic Surgery,
Weligerveld 1, 3212 Lubbeek, Belgium
Tel.: +32-16-338800, Fax: +32-16-338803
Fig. 1 Aspect of the left hand