KIENBOCK'S DISEASE

Kienbock's Disease

Avascular Necrosis (AVN ) of Lunate bone

Stages of Kienbock's disease

    I. normal radiographs , possible stress #

    II. sclerosis of lunate bone, no collapse

    IIIA. fragmentation and early outcome

    IIIB.  stage IIIA + scapholunate dissociation and fixed rotation

        IV.   degeneration changes on lunate. 

What else to look for in radiography ? 

    Negative Ulnar variance on AP taken with forearm on midprone         position. 

    

    What we see on MRI films ?

    low signal intensity in T1 film on the lunate bone.

Management options 

A. Analgesia

     Splintage 

B. Operative 

    Join levelling -Radial shortening 

    Wrist Denervation

    Partial / total wrist fusion 

    Proximal row carpectomy 

    

Choice depends on diseases stage ,degree of symptoms and patient factors.