Mr Jeremy Read
Hand & Wrist Surgeon
Private Secretary

07565 446713
NHS Secretary

01923 217085
Private Secretary 07565 446713
NHS Secretary 01923 217155
Presentation

Kienbock's disease most commonly presents with a gradual onset of pain and stiffness ( often in the dominant wrist ) this may be slowly progressing or advance fairly rapidly. Kienbock's may sometimes however be diagnosed after an injury when x-rays are taken. Fragmentation and collaps of the lunate that is seen may be mistakenly diagnosed as an acute lunate fracture, though with careful questioning there is normally a history of some pre injury wrist symptoms. 
Investigation

The clinical examination findings will depend on the stage of kienbock's , but are likely to show evidence of tenderness over the lunate with a restricted range of motion. 1st line investigation is with X-ray which may not show much in early (stage 1) disease, if however Kienbock's is suspected either based on the X-rays or clinical examination then an MRI might be requested, occasionally a bone scan may be used instead.

The stage of the disease is based on the radiographic findings
Stage Features

I
May see a linear fracture through the lunate but usually normal on X-Ray. MRI shows Signal change throughout the lunate on T1. Bone scan high uptake
II Sclerosis (increased density) of lunate, may be multiple fracture lines but no evidence of collapse
IIIA Lunate has collapsed but no loss of carpal height or flexion of the scaphoid
IIIB Lunate has collapsed and there is loss of carpal hight with flexion of the scaphoid
IV Carpal collapse with arthritic changes in the wrist (radiocarpal or midcarpal)
Diagnosis & Treatment
Stage Features

I
May see a linear fracture through the lunate but usually normal on X-Ray. MRI shows Signal change throughout the lunate on T1. Bone scan high uptake
II Sclerosis (increased density) of lunate, may be multiple fracture lines but no evidence of collapse
IIIA Lunate has collapsed but no loss of carpal height or flexion of the scaphoid
IIIB Lunate has collapsed and there is loss of carpal hight with flexion of the scaphoid
IV Carpal collapse with arthritic changes in the wrist (radiocarpal or midcarpal)