Kienböck disease

Case contributed by Dr Paul Heyworth

Presentation

55 year old right-handed lady with right wrist pain. Pain worse dorsally and with activity.

Patient Data

Age: 55
Gender: Female
X-ray

Right wtrist radiographs

Subtle sclerosis of the lunate bone, without lunate collapse or rotation of the scaphoid bone. There is also negative ulnar variance.

X-ray

Bilateral wrist radiographs - 1 year later

Follow-up radiographs of both wrists 1 year later. The patient is complaining of mild left wrist pain at the time of review. Sclerosis of the left lunate is noted with mild ulnar variance. No scaphoid rotation or lunate collapse. The right wrist is stable in appearance.

Case Discussion

Kienbock disease correspond to the avascular necrosis of the lunate.

Patients generally present with wrist pain that is worse with activities and more often occurs in the dominant hand.

Can be broken into 4 stages:

  • stage I - no changes on x-ray, but changes on MRI (edema and reduced vascularity of the lunate)
  • stage II - sclerosis of the lunate
  • stage IIIA - lunate collapse without scaphoid rotation
  • stage IIIB - lunate collapse with scaphoid rotation
  • stage IV - degenerated adjacent intercarpal joints

A common association is seen with negative ulnar variance

Treatment can be operative or non-operative. 

 

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Case information

rID: 60141
Published: 9th May 2018
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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