Kienbock Disease Workup

  • Author: Brian J Divelbiss, MD; Chief Editor: Harris Gellman, MD   more...
 
Updated: Oct 26, 2011
 

Imaging Studies

  • Plain radiographs
    • Plain films form the basis for staging and treatment of Kienböck disease. Lichtman's modification of Stahl's classification is most widely used and divides the disease into 5 stages, as follows:
      • Stage I - Normal radiograph
      • Stage II - Increased radiodensity 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
    • Plain films must also be examined to determine the amount of ulnar variance present. This will directly impact the choice of operative technique. A true posteroanterior view of the wrist is necessary to adequately determine ulnar variance.
  • Tomograms
    • Tomograms may be useful in determining the true extent of disease.
    • Tomograms have been found to result in the upgrading of many patients with stage II disease to stage III by more clearly demonstrating collapse.
    • In addition, coronal fractures that split the lunate into volar and dorsal halves are more evident with tomograms.
    • Due to the limited availability of tomograms at this time, a CT scan would be the best imaging modality to evaluate the bony architecture of the lunate.
  • Bone scan
    • Bone scanning may help exclude the presence of Kienböck disease, but it is not specific enough to exclude the many other causes of increased uptake in the area of the lunate.
    • It may be of some help in the patient with known Kienböck disease who develops wrist pain in the contralateral side.
  • MRI
    • MRI is most helpful early in the course of the disease when plain films are not diagnostic.
    • T1- and T2-weighted images reveal decreased signal intensity.
    • Patterns of signal loss can be focal or generalized; however, primary involvement of the ulnar proximal portion of the lunate indicates potential ulnar abutment syndrome.
    • T1-weighted images showing focal loss on the radial half of the lunate suggest early involvement, particularly if the corresponding T2-weighted images show normal or increased intensity.
    • MRI is an extremely sensitive and specific test to detect the presence of marrow changes consistent with osteonecrosis.
    • MRI has also been used to indirectly demonstrate revascularization following operative treatment.
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Contributor Information and Disclosures
Author

Brian J Divelbiss, MD  Attending Staff, Dickson-Diveley Midwest Orthopedic Clinic, Inc, and Kansas City Orthopedic Institute; Associate Clinical Professor, Department of Orthopedic Surgery, University of Missouri-Kansas City

Brian J Divelbiss, MD is a member of the following medical societies: Alpha Omega Alpha and American Society for Surgery of the Hand

Disclosure: Nothing to disclose.

Coauthor(s)

Mark E Baratz, MD  Professor, Department of Orthopaedics, Drexel University College of Medicine; Residency Director, Department of Orthopaedics, Allegheny General Hospital; Consulting Staff, Allegheny Orthopaedic Associates

Mark E Baratz, MD is a member of the following medical societies: Allegheny County Medical Society, American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American Orthopaedic Association, American Society for Surgery of the Hand, Orthopaedic Research Society, and Pennsylvania Orthopaedic Society

Disclosure: Integra Life Sciences Royalty None; Integra Life Sciences Consulting fee Speaking and teaching; Integra Life Sciences Grant/research funds None; Elizur Consulting fee Consulting

Specialty Editor Board

A Lee Osterman, MD  Director of Hand Surgery Fellowship, Director, Philadelphia Hand Center; Director, Professor, Department of Orthopedic Surgery, Division of Hand Surgery, University Hospital, Thomas Jefferson University

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

N Ake Nystrom, MD, PhD  Associate Professor of Orthopedic Surgery and Plastic Surgery, University of Nebraska Medical Center

Disclosure: Nothing to disclose.

Dinesh Patel, MD, FACS  Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD  Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society

Disclosure: Nothing to disclose.

References

  1. Gay AM, Parratte S, Glard Y, Mutaftschiev N, Legre R. Isolated capitate shortening osteotomy for the early stage of Kienböck disease with neutral ulnar variance. Plast Reconstr Surg. Aug 2009;124(2):560-6. [Medline].

  2. Takahara M, Watanabe T, Tsuchida H, Yamahara S, Kikuchi N, Ogino T. Long-term follow-up of radial shortening osteotomy for Kienbock disease. Surgical technique. J Bone Joint Surg Am. Oct 1 2009;91 Suppl 2:184-90. [Medline].

  3. Gelberman RH, Bauman TD, Menon J. The vascularity of the lunate bone and Kienbock's disease. J Hand Surg [Am]. May 1980;5(3):272-8. [Medline].

  4. Gelberman RH, Salamon PB, Jurist JM. Ulnar variance in Kienbock's disease. J Bone Joint Surg Am. Jul 1975;57(5):674-6. [Medline].

  5. De Smet L. Ulnar variance: facts and fiction review article. Acta Orthop Belg. 1994;60(1):1-9. [Medline].

  6. Illarramendi AA, De Carli P. Radius decompression for treatment of Kienbock disease. Tech Hand Up Extrem Surg. 2003;7:110-3. [Medline].

  7. Iwasaki N, Minami A, Ishikawa J, Kato H, Minami M. Radial osteotomies for teenage patients with Kienböck disease. Clin Orthop Relat Res. Oct 2005;439:116-22. [Medline].

  8. Elhassan BT, Shin AY. Vascularized bone grafting for treatment of Kienböck's disease. J Hand Surg Am. Jan 2009;34(1):146-54. [Medline].

  9. Simmons SP, Tobias B, Lichtman DM. Lunate revascularization with artery implantation and bone grafting. J Hand Surg Am. Jan 2009;34(1):155-60. [Medline].

  10. Mathoulin C, Wahegaonkar AL. Revascularization of the lunate by a volar vascularized bone graft and an osteotomy of the radius in treatment of the Kienböck's disease. Microsurgery. 2009;29(5):373-8. [Medline].

  11. Sheetz KK, Bishop AT, Berger RA. The arterial blood supply of the distal radius and ulna and its potential use in vascularized pedicled bone grafts. J Hand Surg [Am]. Nov 1995;20(6):902-14. [Medline].

  12. Beck E. Os pisiforme transfer. Orthopade. Apr 1986;15(2):131-4. [Medline].

  13. Mazur KU, Bishop AT, Berger RA. Vascularized metaphyseal bone grafts from the distal radius in the treatment of Kienbock's disease. Orthopaedic Transactions. 1997;21:244.

  14. Kremer T, Sauerbier M, Trankle M, Dragu A, Germann G, Baumeister S. Functional results after proximal row carpectomy to salvage a wrist. Scand J Plast Reconstr Surg Hand Surg. 2008;42(6):308-12. [Medline].

  15. Mehrpour SR, Kamrani RS, Aghamirsalim MR, Sorbi R, Kaya A. Treatment of kienböck disease by lunate core decompression. J Hand Surg Am. Oct 2011;36(10):1675-7. [Medline].

  16. Kristensen SS, Thomassen E, Christensen F. Kienbock's disease--late results by non-surgical treatment. A follow-up study. J Hand Surg [Br]. Oct 1986;11(3):422-5. [Medline].

  17. Delaere O, Dury M, Molderez A. Conservative versus operative treatment for Kienbock's disease. A retrospective study [see comments]. J Hand Surg [Br]. Feb 1998;23(1):33-6. [Medline].

  18. Mikkelsen SS, Gelincek J. Poor function after nonoperative treatment of Kienbock's disease. Acta Orthopedica Scandinavia. 1987;58:241-243.

  19. Lichtman DM, Alexander AH, Mack GR. Kienbock's disease--update on silicone replacement arthroplasty. J Hand Surg [Am]. Jul 1982;7(4):343-7. [Medline].

  20. Quenzer DE, Dobyns JH, Linscheid RL. Radial recession osteotomy for Kienbock's disease. J Hand Surg [Am]. May 1997;22(3):386-95. [Medline].

  21. Weiss AP. Radial shortening. Hand Clin. Aug 1993;9(3):475-82. [Medline].

  22. Weiss AP, Weiland AJ, Moore JR, Wilgis EF. Radial shortening for Kienböck disease. J Bone Joint Surg Am. Mar 1991;73(3):384-91. [Medline].

  23. Watson HK, Monacelli DM, Milford RS. Treatment of Kienbock's disease with scaphotrapezio-trapezoid arthrodesis. J Hand Surg [Am]. Jan 1996;21(1):9-15. [Medline].

  24. Zelouf DS, Ruby LK. External fixation and cancellous bone grafting for Kienbock's disease: a preliminary report. J Hand Surg [Am]. Sep 1996;21(5):746-53. [Medline].

  25. Aspenberg P, Wang JS, Jonsson K. Experimental osteonecrosis of the lunate. Revascularization may cause collapse. J Hand Surg [Br]. Oct 1994;19(5):565-9. [Medline].

  26. Begley BW, Engber WD. Proximal row carpectomy in advanced Kienbock's disease. J Hand Surg [Am]. Nov 1994;19(6):1016-8. [Medline].

  27. Bochud RC, Buchler U. Kienbock's disease, early stage 3--height reconstruction and core revascularization of the lunate. J Hand Surg [Br]. Aug 1994;19(4):466-78. [Medline].

  28. Bonzar M, Firrell JC, Hainer M. Kienbock disease and negative ulnar variance [see comments]. J Bone Joint Surg Am. Aug 1998;80(8):1154-7. [Medline].

  29. Condit DP, Idler RS, Fischer TJ. Preoperative factors and outcome after lunate decompression for Kienbock's disease. J Hand Surg [Am]. Jul 1993;18(4):691-6. [Medline].

  30. Hashizume H, Asahara H, Nishida K. Histopathology of Kienbock's disease. Correlation with magnetic resonance and other imaging techniques. J Hand Surg [Br]. Feb 1996;21(1):89-93. [Medline].

  31. Jensen CH, Thomsen K, Holst-Nielsen F. Radiographic staging of Kienbock's disease. Poor reproducibility of Stahl's and Lichtman's staging systems. Acta Orthop Scand. Jun 1996;67(3):274-6. [Medline].

  32. Menth-Chiari WA, Poehling GG, Wiesler ER. Arthroscopic debridement for the treatment of Kienbock's disease. Arthroscopy. Jan-Feb 1999;15(1):12-9. [Medline].

  33. Miura H, Sugioka Y. Radial closing wedge osteotomy for Kienbock's disease. J Hand Surg [Am]. Nov 1996;21(6):1029-34. [Medline].

  34. Nakamura R, Horii E, Watanabe K. Proximal row carpectomy versus limited wrist arthrodesis for advanced Kienbock's disease. J Hand Surg [Br]. Dec 1998;23(6):741-5. [Medline].

  35. Nakamura R, Watanabe K, Tsunoda K. Radial osteotomy for Kienbock's disease evaluated by magnetic resonance imaging. 24 cases followed for 1-3 years. Acta Orthop Scand. Apr 1993;64(2):207-11. [Medline].

  36. Quenzer DE, Linscheid RL, Vidal MA. Trispiral tomographic staging of Kienbock's disease. J Hand Surg [Am]. May 1997;22(3):396-403. [Medline].

  37. Sakai A, Toba N, Oshige T, Menuki K, Hirasawa H, Nakamura T. Kienböck disease treated by excisional arthroplasty with a palmaris longus tendon ball: a comparative study of cases with or without bone core. Hand Surg. Dec 2004;9(2):145-9. [Medline].

  38. Salmon J, Stanley JK, Trail IA. Kienböck's disease: conservative management versus radial shortening. J Bone Joint Surg Br. Aug 2000;82(6):820-3. [Medline].

  39. Sennwald GR, Ufenast H. Scaphocapitate arthrodesis for the treatment of Kienbock's disease. J Hand Surg [Am]. May 1995;20(3):506-10. [Medline].

  40. Takase K, Imakiire A. Lunate excision, capitate osteotomy, and intercarpal arthrodesis for advanced Kienböck disease. Long-term follow-up. J Bone Joint Surg Am. Feb 2001;83-A(2):177-83. [Medline].

  41. Thienpont E, Mulier T, Rega F, De Smet L. Radiographic analysis of anatomical risk factors for Kienbock's disease. Acta Orthop Belg. 5/2004;70:406-9. [Medline].

  42. Trail IA, Linscheid RL, Quenzer DE. Ulnar lengthening and radial recession procedures for Kienbock's disease. Long-term clinical and radiographic follow-up. J Hand Surg [Br]. Apr 1996;21(2):169-76. [Medline].

  43. Trumble T, Glisson RR, Seaber AV. A biomechanical comparison of the methods for treating Kienbock's disease. J Hand Surg [Am]. Jan 1986;11(1):88-93. [Medline].

  44. Watanabe K, Nakamura R, Imaeda T. Arthroscopic assessment of Kienbock's disease. Arthroscopy. Jun 1995;11(3):257-62. [Medline].

  45. Watson HK, Guidera PM. Aetiology of Kienbock's disease. J Hand Surg [Br]. Feb 1997;22(1):5-7. [Medline].

 
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