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Kienbock’s disease is a rare entity involving collapse of the lunate due to avascular necrosis and vascular insufficiency.
Occurs most commonly in young adults aged 15 to 40 years.
Cause is unknown but believed to be due to remote trauma or repetitive microtrauma in at risk individuals.
Patients complain of wrist pain, stiffness and swelling
On exam, limited range of motion, decreased grip strength and passive dorsiflexion of the 3rd digit produces pain.
Dx: plain film in the ED and with MRI as an outpatient.
Tx: Wrist immobilization with splint and refer to orthopedics. Ultimate treatment is individualized and there is no clear consensus.
Lunate sclerosis seen on plain film
http://orthoinfo.aaos.org/figures/A00017F02.jpg
AVN of the lunate seen on MRI
http://www.assh.org/Public/HandConditions/PublishingImages/KeinbocksMRI_figure3.JPG