The pisiform is a sesamoid bone in the wrist. Located on the upper section of the carpal bones below the smallest finger, the pea-shaped structure resides in the flexor carpi ulnaris or FCU that enables flexion and adduction of the hand. The pisiform acts as a pulley for the FCU and the abductor digiti minimi muscles as well as tendons and ligaments. Along with the hamate, it forms a fibro-osseous structure called the Guyon canal, a pathway for the ulnar nerve and artery.

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