UMEM Educational Pearls

Category: Orthopedics

Title: 25yo with left wrist pain, stiffness and mild swelling

Keywords: AVN, wrist pain, lunate (PubMed Search)

Posted: 7/23/2022 by Brian Corwell, MD (Updated: 8/15/2022)
Click here to contact Brian Corwell, MD

Question

Answer

Kienbock’s disease: collapse of the lunate due to avascular necrosis and vascular insufficiency.

Occurs most commonly in young adults aged 20 to 40 years.

Cause is unknown but believed to be due to remote trauma or repetitive microtrauma in at risk individuals.

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 as treatment is individualized.