Kienböck disease

Case contributed by Dr Mahmoud Yacout Alabd

Presentation

Wrist pain. Abnormal appearance of the lunate bone on x-ray.

Patient Data

Age: 20 years
Gender: Male
X-ray

Sclerosis of the lunate bone. Negative ulnar variance is also seen with shortening of the distal ulna in relation to the distal radius.

MRI

The lunate bone is relatively small sized and collapsed, reflecting diffusely abnormal signal and edema of its marrow, being low on T1 and T2 and heterogenous bright signal on STIR.

Case Discussion

Kienböck disease is the name given to avascular necrosis of the lunate bone. The exact cause of the condition is not known, however there is a strong association with negative ulnar variance as in this patient. Typical MRI appearance including low signal on T1 and T2 due to sclerosis with some heterogenous fluid bone marrow signal on fat suppression.

The lunate bone appears collapsed with an irregular surface. Degenerative changes are seen in the form of a few small periarticular ganglions related to the wrist joint, mild cortical erosion and irregularities of the articular surface of radius as well as the carpal bones, notably the posterolateral aspect of scaphoid. There are also a few small subarticular cysts of the trapezium, triquetrum and trapezoid bones.

Minimal  joint effusion noted.

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