PISIFORM
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Copyright © Alastair McLoughlin 2015 Revised © Alastair McLoughlin 2019 and 2022
The right of Alastair McLoughlin to be identified as the original Designer, Developer and Author of the Work has been asserted by him in accordance with the Copyright, Design and Patents Act 1998.
All rights reserved. No part of this text may be reproduced, stored in a retrieval system, or transmitted in any form or by any means without the prior written permission of the publisher, nor be otherwise circulated in any form of binding or cover, or reprinted in any physical or electronic manner without the written consent of the author.
The ideas and concepts explored within this text are those of the author. For educational purposes only.
No diagnosis is being offered nor any cure promised by the application of this information.
Alastair McLoughlin cannot be held responsible for any injury arising from the application of this work by the practitioner to any third party however caused.
This work is not a substitute for medical attention. Please seek your physician’s advice if in doubt.
You won’t need this work very frequently - but when you do you will be amazed at the speed at which this works!
Use these AoB moves to get (in most cases) immediate improvement in problems of ulnar deviation.
See the instructional video presentation for clarification and exact finger placement.
INDICATIONS FOR USEProblems with ulna deviation - i.e. the wrist cannot be bent towards the ulnar side - as shown in the video.
You may think the lack of ulna deviation isn’t very important.
After all - how could that really affect someone in their daily life?
Ulna deviation is extremely important to anyone who needs good manual dexterity with their hands.
Lack of ulna deviation could mean you’d get a pain just by using a computer keyboard, placing your hands in the 10 to 2 position on the steering wheel when driving a vehicle.
You could get the pain carrying a bag or suitcase, using a hammer or other tools such as a screwdriver, playing golf … there are literally hundreds of daily operations that require good ulna deviation of the hand.
CAUTIONS OR CONTRAINDICATIONS Please exclude the possibility of any bony fracture or problem due to a recent injury that persists and is not responding to treatment.
Refer for medical diagnosis if you are unsure about any undiagnosed medical condition.
The assessment can be painful and will display limited range of motion.
Position of the patient and preliminary assessement:Standing or seated for both assessment and application of AoB moves.
Ask the client to take the hand into ulna deviation as shown in the video presentation.
Note the range of movement so a comparison can be made post-treatment.
Pain is often felt on the ulna side of the wrist when the hand is deviated in the 20 to 30 degree range of deviation to the ulna side.
No pain is usually felt from zero to 20 degrees of deviation.
Move past 20 degrees of abduction and the pain can be felt sharply and quickly at the point indicated by this symbol:
Secondary Assessment:Do not perform the assessment if there is a risk of fracture.
Locate the correct direction (vector) for the move.
By palpation you will be able to feel the pisiform bone and its position relative to the other bony structures.
The pisiform can deviate in four ways.
This is shown as arrow markers in the video presentation:
a) Laterally (towards the ulna border of the hand)b) Distally (towards the little finger)c) Proximally (towards the wrist)d) Palmar (where the pisiform ‘drops’ into a position towards the palm of the hand)
Accurate assessment of the misplaced pisiform will indicate in which direction the remedial move will be applied.
Match the number on screen to the following vectors of deviation.
If the pisiform has shifted:
a) Laterally - move in the direction shown as 1b) Distally - move in the direction shown as 2c) Proximally - move in the direction shown as 3d) Palmar - move in the direction shown as 4
Application of the AoB procedure:Support the patient’s hand as shown.
See the instructional video presentation for clarification and exact placement of the operator’s finger and thumb.
Palpate the pisiform as shown in (a).
The AoB moves are shown in sequence:
If the pisiform has shifted:
a) Laterally - move in the direction shown as 1b) Distally - move in the direction shown as 2c) Proximally - move in the direction shown as 3d) Palmar - move in the direction shown as 4
Please note: Only ONE direction should be used to resolve the problem.
The move you select will be based upon your assessment of the pisiform and the direction in which it has been displaced.
In my experience a) move 1 and d) move 4 are the most common directions of displacement.
Reassessment:Reassess the client - as shown - by asking the client to move their hand into ulna deviation.
There should be an immediate release and freedom of movement in the wrist.
Repeating this move is not usually necessary if you have carefully assessed the direction of displacement and selected the correct vector with which to make the correction.
As this AoB procedure is so rapid it may be added at the end of any treatment session - or used as a stand-alone piece of work as a quick and speedy answer to problems with ulna deviation.
How it works:The pisiform has a flat articular surface, it relies mainly on its many soft tissue attachments for stability such as Flexor Carpi Ulnaris tendon, ulnar pisotriquetral ligament, pisometacarapal and pisohamate ligament being primary stabilisers of pisotriquetral joint.
Because of the insertion of all these structures, the pisiform is an important stabilising structure of the wrist and also acts as a lever to provide extra stability when the wrist is flexed.
Practice is needed to locate and palpate the pisiform.
By palpating many correctly placed pisiform bones we will be able to quickly distinguish when the pisiform is out of position.
Movement of the hand in ulna deviation is a quick method of determining if the movement is restricted.
Once that is observed it is a relatively quick release to help realignment.
Ulna deviation that has been restricted for many years will correct in a single moment using this AoB work.
Remember to select the correct vector which is dependent on the angle of displacement of the pisiform.
In cases of non-responsiveness then there may be calcification of the carpus.
In cases where pain persists then you may suspect an unidentified fracture - refer for medical diagnosis.
