Presentation
Chronic wrist pain
Patient Data
Presence of hypointense signal on T1 and hyperintense on STIR sequences, affecting the lunate bone, with some patchy areas of preserved bone marrow signal.
There is no lunate collapse or scapholunate instability.
Negative ulnar variance.
Rest of the study without other particularities.
Case Discussion
The findings are suggestive of osteonecrosis of the lunate (Kienböck's disease).
Like other bones in the body, the semilunar bone presents "bare areas", in this particular case, since it is mostly covered by articular cartilage, there are only small areas accessible to the nutritional vessels in the dorsal and palmar poles (pattern Y-shaped blood supply).
MRI is an extremely appropriate method when Kienbock's disease is suspected since it allows determining the presence of bone edema, collapse, and scapholunate instability, key data for considering therapeutic behavior. For this, a Stahl classification system is modified by Lichtman.
In our case, it would correspond to stage II, since bone edema is observed, with no current evidence of collapse or scapholunate instability.