Kienbock disease

Case contributed by Dr Saman Nasrollazadeh


Construction worker presents with wrist pain for two months, which deteriorates with activity and decreases with resting. He mentions no recent trauma.

Patient Data

Age: 30 years
Gender: Male

Increased radiodensity of the lunate which with loss of bone volume. 

The remainder of the carpal bones are normal.

Annotated image

Sclerotic collapsed lunate indicated by red arrow. 

Case Discussion

Kienbock disease is a condition of unknown etiology.

The clinical presentation is chronic wrist pain with no history of trauma.

Plain films form the basis for staging and treatment of Kienbock disease.

Lithcman's modification of Stahl's classification is most widely used and divides the disease into five stages,as follows:

  • stage I: Normal radiograph
  • stage II: lncreased radiodensity of the lunate with possible decrease of lunate height on the radial side only
  • stage III
    • IIIa: Lunate collapse, no scaphoid rotation
    • IIIb: Lunate collapse, fixed scaphoid rotation
  • stage IV: Degenerative changes around lunate. According to above classification this patient includes stage II.

  This case demonstrates stage II Stahl's classification of avascular necrosis of the lunate.

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Case information

rID: 51931
Published: 16th Mar 2017
Last edited: 28th Nov 2019
Inclusion in quiz mode: Included

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