Mr Jeremy Read
Consultant Orthopaedic Hand & Wrist Surgeon
07565 446713 info@hertshandsurgeon.com
Mr Jeremy Read
Surgeon
Herts
Hand
Surgeon
Herts
Hand
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.
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
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) |
