Avascular necrosis of scaphoid
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Synopsis
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:
- Trauma or microtrauma
- Tobacco use
- Corticosteroid use
- Chemotherapy
- Systemic diseases (eg, autoimmune hemolytic anemia, systemic lupus erythematosus, and post renal transplantation)
- Thumb hypoplasia
Prevalence:
- 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.
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.
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.
Codes
ICD10CM:M87.039 – Idiopathic aseptic necrosis of unspecified carpus
SNOMEDCT:
397758007 – Avascular necrosis of bone
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Distal radius fracture
- Carpal tunnel syndrome
- Kienböck disease (avascular necrosis of the lunate bone)
- De Quervain tenosynovitis
- Carpometacarpal joint osteoarthritis
- Intersection syndrome
- Triangular fibrocartilage complex tear
- Ligamentous sprain (see wrist sprain)
- Ganglion cyst of wrist
- Trapezium fracture
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:09/25/2022
Last Updated:11/09/2022
Last Updated:11/09/2022
Avascular necrosis of scaphoid