Kienbock’s
disease
The aetiology is unclear, but probably involves both ischaemia and
microtrauma in the lunate, causing sclerosis initially, then collapse and
finally arthritis. Many patients have a relatively short ulna (‘negative ulnar
variance’). Patients complain of pain and weakness in the wrist. Very early,
bone scan or MRI can detect disease before it shows on plain radiographs.
Treatment is initially conservative, with splintage, avoidance of activity and
simple analgesics. Surgical shortening of the radius reduces the compressive
forces across the lunate and may help those with early disease. In advanced
cases with painful osteoarthritis around the lunate, radiocarpal fusion is the
most reliable treatment.