Presentation
Severe pain in wrist
Patient Data
Avascular necrosis of lunate is seen with sclerosis, collapse and fragmentation. Cystic changes and marrow oedema 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 oedema is seen.
Subchondral erosions are also seen in radial aspects of triquetrum, ulnar aspects of scaphoid, with mild marrow oedema 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 oedema 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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