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.