Kienböck disease

Case contributed by Utkarsh Kabra


Severe pain in wrist

Patient Data

Age: 45 years
Gender: Female

Avascular necrosis of lunate is seen with sclerosis, collapse and fragmentation. Cystic changes and marrow edema is also seen.
Significantly reduced capito-lunate joint space is seen with subchondral erosions and large cyst, measuring approx. 8 x 14mm in capitate. Surrounding marrow edema is seen.
Subchondral erosions are also seen in radial aspects of triquetrum, ulnar aspects of scaphoid, with mild marrow edema in triquetrum.
Complete tear of styloid attachment of triangular fibrocartilage complex (TFCC) with partial tears of foveal, radial attachments. Partial tears of meniscal homologue, dorsal and volar radiocarpal ligaments also seen.
Mild tendinosis of extensor carpi ulnaris tendon is seen.
Soft tissue edema is seen around intercarpal joints.
Subtle focal subchondral erosion is seen in proximal aspects of hamate.
Small marginal osteophytes are seen along triscaphe joint.

Case Discussion

Overall findings are suggestive of stage IV Kienböck disease( Stahl classfication) with extensive secondary degenerative changes as described.

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