Treatment of gout combined with Kienböck's disease: A case report

Abstract

Cases of Kienböck's disease combined with gout are rare; to the best of our knowledge, the current report is the third such case reported in the literature. The current report presents the case of a 49-year-old male patient with Kienböck's disease combined with gout. The patient had experienced swelling and pain of their right wrist for 1 month. Through a combination of clinical history, physical examination, laboratory results, radiological and intraoperative findings, the patient was diagnosed with stage IIIB-IV Kienböck's disease and gout. The patient recovered well following a synovectomy and medication for gout. The rarity of the present case makes it difficult to examine the potential association between gout and Kienböck's disease. Kienböck's disease combined with gout tends to be ignored and is easily misdiagnosed. However, the surgical procedure selection for Kienböck's disease combined with gout is markedly different from the conventional surgery for Kienböck's disease or gout alone. The current study outlines a successful treatment strategy for gout combined with Kienbock's disease.

Keywords: Kienböck's disease; gout; wrist pain.

Figure 1.

Pre-operative image of the right wrist, which exhibited swelling.

Figure 2.

Pre-operative radiograph of the right wrist. Radiographic images revealed a blurred joint surface in the distal radius, the proximal pole of the lunate and the scaphoid (black arrow). In addition, narrowing of the joint space, sclerosis and collapse of the lunate bone were observed (red arrow).

Figure 3.

Computed tomography image of the right wrist pre-operatively. Lunate bone sclerosis with subchondral small cysts, a decrease of lunate height and a narrowing joint space of the distal radiocarpal joint were observed (red arrow).

Figure 4.

Magnetic resonance imaging of the right wrist pre-operatively. The scan revealed a low signal intensity in the lunate bone on T1-weighted images (left) and small pieces of high signal intensity on T2-weighted images (right). The synovium exhibited obvious thickening on the dorsal radiocarpal joint.

Figure 5.

Image of the right wrist during open extra-articular synovectomy, indicating multiple monosodium urate crystal deposits on the synovial membrane of the carpus (red arrow).

Figure 6.

Radiograph performed 2 years after the synovectomy with arthroscopy, revealing no degeneration of the wrist.