SynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyDrug Reaction DataReferences
Avascular necrosis of scaphoid
Other Resources UpToDate PubMed

Avascular necrosis of scaphoid

Contributors: Sophia Mavrommatis, Danielle Wilbur MD
Other Resources UpToDate PubMed


Preiser disease refers to idiopathic avascular necrosis of the scaphoid bone.

Causes / typical injury mechanism: Preiser disease is a rare condition with an unclear etiology. Possible causes for Preiser disease include:
Classic history and presentation: Preiser disease commonly manifests as chronic, radial-sided wrist pain. There is usually no identifiable trauma that precipitates this pain. Range of motion is typically limited, and grip strength is often reduced.

  • Age – Preiser disease affects people of all ages but is typically diagnosed in middle-aged adults.
  • Sex / gender – Some evidence suggests that women are affected more than men.
Risk factors: Smoking, alcohol use disorder, infection, and a history of trauma to the region are all risk factors for Preiser disease.

Pathophysiology: The scaphoid has a retrograde blood supply and a poorly vascularized proximal pole. The limited vascularity of the scaphoid causes it to be particularly sensitive to occlusion, which can thus lead to avascular necrosis.

Grade / classification system:
Several classification systems exist.

Herbert-Lanzetta classification
This classification system grades Preiser disease based on the appearance of the scaphoid on plain radiographs. The stages are as follows:
  • Stage 1 – The plain radiograph is normal, but increased uptake is observed on bone scan.
  • Stage 2 – Increased density of the scaphoid's proximal pole.
  • Stage 3 – Fragmentation of the proximal pole of the scaphoid with or without pathologic fracture.
  • Stage 4 – Osteoarthritis and carpal collapse.
Kalainov classification
This classification system grades Preiser disease based on the scaphoid's appearance on MRI.
  • Type 1 – Involvement of the entire scaphoid.
  • Type 2 – Involvement of the proximal pole of the scaphoid.
Type 1 carries a worse prognosis than type 2.


M87.039 – Idiopathic aseptic necrosis of unspecified carpus

397758007 – Avascular necrosis of bone

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

To perform a comparison, select diagnoses from the classic differential

Subscription Required

Best Tests

Subscription Required

Management Pearls

Subscription Required


Subscription Required

Drug Reaction Data

Subscription Required


Subscription Required

Last Reviewed:09/25/2022
Last Updated:12/26/2022
Copyright © 2024 VisualDx®. All rights reserved.
Avascular necrosis of scaphoid
Copyright © 2024 VisualDx®. All rights reserved.