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Case Reports
. 2012 Dec;56(4):275-82.

Kienbock's disease in a varsity football player: a case report and review of the literature

Michelle A Laframboise  1 , Robert Gringmuth, Christopher Greenwood
Affiliations
Case Reports

Kienbock's disease in a varsity football player: a case report and review of the literature

Michelle A Laframboise et al. J Can Chiropr Assoc. 2012 Dec.

Abstract
in English, French

Objective: To present the diagnostic, clinical features, and management of Kienbock's disease and create awareness of the differential diagnosis of this condition in patients presenting with insidious, progressive dorsal wrist pain.

Clinical features: A 23-year old male varsity football player presented with insidious progressive dorsal sided wrist pain with reduced wrist flexion and extension. A diagnosis of Kienbock's disease was made based on radiographs and magnetic resonance imaging.

Intervention and outcome: A 3mm ulnar-minus variance was found and a joint leveling procedure to shorten the radius was performed. Conservative therapy was provided pre and post surgical management.

Summary: This case report demonstrates the importance of findings on radiographs, MRI, and clinical examination in the accurate diagnosis and management of a patient with wrist pain.

Objectif :: Présenter le diagnostic, les caractéristiques cliniques et le traitement de la maladie de Kienböck, et susciter une conscientisation quant au diagnostic différentiel de ce trouble chez les patients qui présentent une douleur insidieuse et progressive à la face dorsale du poignet.

Caractéristiques cliniques :: Un joueur de football universitaire de 23 ans présente une douleur insidieuse et progressive du côté dorsal du poignet avec réduction de la flexion et de l’extension du poignet. Le diagnostic de maladie de Kienböck est établi d’après des radiographies et l’imagerie par résonnance magnétique.

Intervention et résultat :: Une divergence ulnaire négative de 3 mm est décelée et une procédure de nivellement de l’articulation visant à raccourcir le radius a été effectuée. Une thérapie conservatrice a été administrée avant et après l’intervention chirurgicale.

Résumé :: La présente étude de cas témoigne de l’importance des éléments trouvés au moyen des radiographies, de l’IRM et de l’examen clinique dans l’établissement d’un diagnostic exact et dans l’intervention menée chez le patient souffrant de douleur au poignet.

Keywords: Kienbock; Kienbock’s disease; avascular necrosis; lunate; lunatomalacia; osteonecrosis.

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Figures

Figure 1:
Figure 1:
Left AP wrist radiograph at initial presentation shows collapse and subchondral fracture of left lunate (arrow) and a 3mm negative ulnar variant (arrowhead)
Figure 2:
Figure 2:
Left Sagittal TI MRI taken at initial presentation shows fragmentation and collapse of left lunate
Figure 3:
Figure 3:
Left AP wrist radiograph, the arrow shows a left radial shortening procedure of 3mm 6 months after initial diagnosis Kienbock’s disease
Figure 4:
Figure 4:
Left lateral radiograph, the arrow shows the left radial shortening procedure of 3mm after initial diagnosis of Kienbock’s disease. Arrowhead shows osteotomy scar in the proximal radius.
See this image and copyright information in PMC

References

    1. Kienböck R. Concerning traumatic malacia of the lunate and its consequences: degeneration and compression fractures. Clin Orthop Relat Res. 1980;149:4–8. - PubMed
    1. Lamas C, Carrera A, Proubasta I, Llusa M, Majo J, Mir X. The anatomy and vascularity of the lunate: considerations applied to Kienbock’s disease. Chir Main. 2007;26:13–20. - PubMed
    1. Schuind F, Eslami S, Ledoux P. Kienbock’s disease. J Bone Joint Surg (Br) 2008;90(2):133–9. - PubMed
    1. Peltier LF. The classic: concerning traumatic malacia of the lunate and its consequences: degeneration and compression fractures. Clin Orthop. 1980;149:4–8. - PubMed
    1. Ståhl F. On lunatomalacia (Kienböck’s disease): a clinical and roentgenological study, especially on its pathogenesis and late results of immobilization treatment. Acta Chir Scand. 1947;126(Suppl):1–133.

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