Presentation
Construction worker presents with wrist pain for two months, which deteriorates with activity and decreases with resting. He mentions no recent trauma.
Patient Data
Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.
Increased radiodensity of the lunate which with loss of bone volume.
The remainder of the carpal bones are normal.
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: increased radiodensity of the lunate with a possible decrease of lunate height on the radial side only
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stage III
IIIa: lunate collapse, no scaphoid rotation
IIIb: lunate collapse, fixed scaphoid rotation
stage IV: Degenerative changes around the lunate. According to the 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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