Presentation
Chronic right wrist pain with tenderness to palpation of the dorsal lunate and positive right Tinel’s sign
Patient Data
Sclerosis and decreased size of the lunate. The bones are aligned with no acute fractures visible. The regional soft tissues show no abnormality.
Negative ulnar variance with sclerosis and edema of the lunate. Deformity and edema of the proximal triquetrum and ulnar styloid. A small tear of the triangular fibrocartilage ligament. Degenerative changes with edema-like changes of the carpal bones and 1st CMC joint. Small distal radioulnar joint effusion with small erosion at the distal radius at the radioulnar joint. Hyperintensity of the proximal hamate with a type II lunate. Increased scapholunate angle without apparent scapholunate ligament tear.
Case Discussion
Sclerosis and edema of a deformed lunate with negative ulnar variance are most consistent with Kienböck's disease. Adjacent findings are consistent with possible contaminant ulnar-triquetral abutment syndrome, torn triangular fibrocartilage, and hamatolunate impingement syndrome.
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