Kienböck disease

Case contributed by Dr Heba Abdelmonem

Presentation

Pain and localized tenderness

Patient Data

Age: Adult
Gender: Male
MRI

Abnormally small size of the lunate with complete loss of the T1 bone marrow signal. Concomitant increased signal is seen in both T2WI and PD fat sat images. Sagittal images demonstrate coronal fracture of the lunate with subsequent collapse on the coronal plane and elongation on the sagittal plane. There is also negative ulnar variance with compensatory hypertrophy of the triangular fibrocartilage. The scapholunate interval is still preserved. Accidentally seen two small scaphoid and capitate intraosseous cysts.

Case Discussion

MRI findings are consistent with stage III Kienböck disease.

Kienbock’s disease may be staged based upon its MR appearance:

  • Stage 0 -a low signal linear fracture line within the mid lunate on T1-weighted images. No diffuse marrow signal abnormality. No change in the plain x-ray film..
  • Stage I -MR demonstrates focal or diffusely reduced T1 signal. Localized low T2 signal may be seen secondary to hemorrhage. Increased signal  on STIR or fat-suppressed T2-weighted exams. Plain are still normal.
  • Stage II -Lunate becomes totally of low signal on T1-weighted images and heterogeneously increased signal on T2-weighted. Sclerosis is evident on plain films.
  • Stage III – Coronal fracture of the lunate lunate with progressive lost height in the coronal plane and elongation in the sagittal plane. The scapholunate interval might increase.
  • Stage IV – All of the stage III features are present with subsequent arthritic changes of the carpal arches.
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Case information

rID: 61341
Published: 28th Jun 2018
Last edited: 16th Jul 2018
Inclusion in quiz mode: Included
Institution: Zagazig University Hospital

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