Summary Kienbock's Disease is the avascular necrosis of the lunate which can lead to progressive wrist pain and abnormal carpal motion. Diagnosis can be made with wrist radiographs in advanced cases but may require MRI for detection of early disease. Treatment is NSAIDs and observation in minimally symptomatic patients. A variety of operative procedures are available depending on severity of disease and patient's symptoms. Epidemiology Incidence most common in males between 20-40 years old Risk factors history of trauma Etiology Pathophysiology thought to be caused by multiple factors login to view 11 more bullets Anatomy Blood supply to lunate 3 variations login to view 5 more bullets Classification Lichtman Classification Stage Description Treatment Stage I No visible changes on xray, changes seen on MRI Immobilization and NSAIDS Stage II Sclerosis of lunate Joint leveling procedure (ulnar negative patients) Radial wedge osteotomy or STT fusion (ulnar neutral patients) Distal radius core decompression Revascularization procedures Stage IIIA Lunate collapse, no scaphoid rotation Same as Stage II above Stage IIIB Lunate collapse, fixed scaphoid rotation Proximal row carpectomy, STT fusion, or SC fusion Stage IV Degenerated adjacent intercarpal joints Wrist fusion, proximal row carpectomy, or limited intercarpal fusion Presentation Symptoms dorsal wrist pain login to view 2 more bullets Physical exam inspection and palpation login to view 2 more bullets range of motion login to view 2 more bullets Imaging Radiographs recommended views login to view 1 more bullet findings (see table above) CT most useful once lunate collapse has already occurred best for showing login to view 3 more bullets MRI best for diagnosing early disease rule out ulnar impaction findings login to view 2 more bullets Treatment Nonoperative observation, immobilization, NSAIDS login to view 4 more bullets Operative temporary scaphotrapeziotrapezoidal pinning login to view 2 more bullets joint leveling procedure login to view 6 more bullets radial wedge osteotomy login to view 2 more bullets vascularized bone grafts login to view 5 more bullets distal radius core decompression login to view 4 more bullets partial wrist fusions login to view 7 more bullets proximal row carpectomy (PRC) login to view 5 more bullets wrist fusion login to view 4 more bullets total wrist arthroplasty login to view 4 more bullets Techniques Vascularized bone grafts technique login to view 7 more bullets Impact of surgical procedure on radiolunate contact stress Impact of surgical procedure on radiolunate contact stress Operative Procedure % decrease on radiolunate contact stress STT fusion 3% Scaphocapitate fusion 12% Capitohamate fusion 0% Ulnar lengthening of 4mm 45% Radial shortening of 4mm 45% Capitate shortening and capitohamate fusion 66%, but 26% increase in radioscaphoid load Prognosis Progressive and potentially debilitating condition if unrecognized and untreated