Male 23 year old complains of pain in the left wrist. An x-ray showed irregular
and increased density in the lunate bone typical of the disease. Bone scan
depicts a rounded area of moderate increased activity in the lunate bone, left
wrist.
Kienbock's disease is an avascular necrosis of the lunate bone in the wrist, of
unknown origin. Trauma, Negative ulnar variance, high uncovering of the lunate,
abnormal radial inclination and/or a trapezoidal shape of the lunate and the
particular pattern of its vascularity may be predisposing factors. Diagnosis is
made on plain radiographs, MRI can be helpful early in the disease. CT scan is
useful to demonstrate fracture or fragmentation of the lunate. Lichtman
classified Kienböck disease into five stages. There is no strong evidence to
support any particular form of treatment. Patients are improved by temporary
immobilisation of the wrist, radial shortening. Other forms of surgical
treatment have been described.
References:
Schuind F, Eslami S, Ledoux P. Kienbock's disease. J Bone Joint Surg Br. 2008
Feb;90(2):133-9.