47 year old male with joint pain - What do you see and what do you think it is?
Three views of the left wrist.
There is collapse of the left lunate with fragmentation, likely from remote avascular necrosis. Also noted is negative ulnar variance. There is also a remote appearing ununited transverse fracture of the base of the fifth proximal phalanx. Deformity of the distal radius could be related to a remote trauma. Moderate degenerative changes are seen in the first CMP joint, with joint space narrowing, subchondral sclerosis as well as surrounding soft tissue swelling. Flexion deformity at the wrist is again noted with soft tissue swelling over the dorsal aspect of the wrist. Other joint spaces appear grossly preserved. There is no acute fracture or dislocation. Lucency in the first metacarpal head is stable (compared with a prior film) and could represent an enchondroma or focal osteopenia. No periosteal reaction or cortical thickening is present.
Kienböck's Disease (also spelled Kienboeck's disease or Kienbock's disease in the English literature) is an avascular necrosis of the lunate bone.
-> Individuals engaged in manual labor with repeated or single episode of trauma
-> Usually affects men aged 20-40 yrs.
-> Mostly unilateral
-> More often in right wrist
-> Vascular impairment due to acute or chronic injury
-The exact cause is unknown
-> Lunate develops osteonecrosis due to loss of blood supply, causing pain and stiffness in the wrist
-> In late stages, the bone collapses eventually leading to degenerative changes and osteoarthritis in the radiocarpal joint
-> Progressive pain
-> Soft-tissue swelling of wrist
-> The disease can be staged based on radiographic findings
-Lichtman's Radiographic Classification of Kienbock's Disease:
· Stage I - Normal radiograph
· Stage II - Sclerosis of lunate with possible decrease of lunate height on radial side only
· Stage IIIa - Lunate collapse, no scaphoid rotation
· Stage IIIb - Lunate collapse, fixed scaphoid rotation
· Stage IV - Degenerative changes around the lunate
The disease may also be associated with negative ulnar variance (as in this case)
Saturday, 13 February 2010
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