A 16-year-old girl with right wrist pain for several months and new onset wrist swelling was referred for MRI. STIR coronal (A), T1 coronal (B), and T2 sagittal (C) MR images demonstrated diffuse abnormal marrow signal intensity throughout the lunate due to lunate sclerosis. A subchondral fracture line (A, arrow) and early lunate collapse was noted, consistent with avascular necrosis (Kienböck’s disease). Radiograph (D) confirmed lunate sclerosis and early collapse.
Kienböck’s disease, also referred to as lunatomalacia, is characterized by avascular necrosis of the lunate. It most commonly presents in patients between 20 and 40 years old, but may also be seen in younger patients. There is a male predominance of 2:1. The dominant wrist is more commonly affected with a predisposition in individuals with negative ulnar variance. Typical symptoms include central wrist pain that is greater dorsally, weakness, and limited range of motion from associated synovitis.1
Diagnosis of Kienböck’s disease is classically made by plain film with 4 stages identified: (I) normal radiographs, (II) sclerotic changes with normal morphology, (III) lunate collapse, and (IV) radiocarpal or midcarpal degenerative arthritis.2 Stage I is usually suspected clinically and diagnosed with marrow signal changes on MRI, while stages II-IV are generally diagnosed by plain films with MRI and computed tomography (CT) being complementary. Treatment varies based on staging and clinical factors; no single surgical approach is unanimous.
McDonald D, Janitz E. At the Viewbox: Kienböck’s Disease. J Am Osteopath Coll Radiol. 2016;5(1):30.