Presentation
55 year old right-handed lady with right wrist pain. Pain worse dorsally and with activity.
Patient Data
Subtle sclerosis of the lunate bone, without lunate collapse or rotation of the scaphoid bone. There is also negative ulnar variance.
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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