Progressive avascular necrosis of lunate
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Synopsis
Causes / typical injury mechanism: Avascular necrosis of the lunate bone, also known as Kienböck disease, leads to eventual collapse and loss of architecture of the carpal bones, leading to advanced wrist arthritis.Classic history and presentation: This presents as insidious, progressive wrist pain with a history of trauma but negative x-rays in the past.
Prevalence:
- Age – This is most common in men between the ages of 20 and 40 years.
- Sex / gender – Male predominance.
- Ulnar negative wrist variance, which leads to increased radial-lunate contact stress
- Decreased radial inclination
- Repetitive trauma
Lichtman classification
- I: Changes on MRI only
- II: Sclerotic changes in the lunate
- IIIA: Collapse of lunate with NO scaphoid rotation
- IIIB: Collapse of lunate with fixed scaphoid rotation
- IV: Degenerative changes seen in the intercarpal joints
- 0-4 based on the number of articular surfaces that are involved and are "nonfunctional"
Codes
ICD10CM:M87.039 – Idiopathic aseptic necrosis of unspecified carpus
SNOMEDCT:
787484007 – Progressive avascular necrosis of lunate
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Radius / ulna (wrist) fracture
- Wrist sprain
- Scaphoid (or other carpal bone) fracture
- Triangular fibrocartilage complex tear
- Ulnar impaction syndrome
- Ganglion cyst of wrist
- Osteoid osteoma
- Fractures, especially of the scaphoid.
- Kienböck disease is rare and is often a diagnosis of exclusion in the early stages.
Best Tests
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Management Pearls
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Therapy
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References
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Last Reviewed:03/03/2021
Last Updated:09/27/2022
Last Updated:09/27/2022
Progressive avascular necrosis of lunate