Pisohamate Ligament, Anterior View

Description

Running along the ulnar and palmar aspect of the carpus, the pisohamate ligament extends from the pisiform to the hook (hamulus) of the hamate, forming a short, stout fibrous band that lies distal to the ulnar styloid and proximal to the bases of the fourth and fifth metacarpals. From an anterior (palmar) perspective, the pisiform sits proximomedial among the proximal carpal row, while the hamate occupies the distal row more laterally, its hook projecting anteriorly toward the ligament’s distal attachment. Adjacent carpal landmarks, including the triquetrum deep to the pisiform and the capitate radial to the hamate, provide positional context for the ulnar side of the wrist. Small but specific. Clinically, this structure matters because it represents the distal continuation of the flexor carpi ulnaris insertion via the pisiform, transmitting forces toward the ulnar column of the hand and helping define the ulnar border of Guyon’s canal. Fracture of the hook of the hamate, often seen in golfers, baseball players, and racquet sport athletes, can disrupt the pisohamate ligament and contribute to ulnar-sided wrist pain with reduced grip strength. During ulnar nerve decompression at the wrist, appreciating the relationship between the pisiform, hamulus, and the ligament’s course helps orient the surgeon to the pisohamate hiatus and nearby neurovascular structures. Hand surgery and upper-limb anatomy courses use this anterior carpal view to teach pisiform related ligaments and to explain why hook of hamate pathology can mimic tendon or nerve complaints on the ulnar side of the palm. It also suits orthopedic and radiology publications discussing carpal tunnel versus Guyon’s canal differentials, with the bony landmarks clearly supporting correlation to CT, MRI, and oblique wrist radiographs. Anatomical accuracy verified by SciePro's Medical Advisory Board.