Kienbock disease is defined as osteonecrosis of the lunate progressing through advancing stages of avascular necrosis and joint destruction with arthrosis in 3 to 5 years if left untreated. Leeosterman md, in fractures and injuries of the distal radius and carpus, 2009. Recent studies gay et al evaluated the use of a simple capitate osteotomy without arthrodesis, through a dorsal medial approach and fixed with staples, in 11 patients with mild forms stage i to iiia, lichtman classification of kienboc. However, mri is the most sensitive and detects radiographically occult cases. Kienbocks disease, also known as lunatomalacia, was first described in the literature by robert kienbock in 1910 as ligamentous trauma to the lunate resulting in the interruption of internal arterial supply to the bone. The incentives for developing a nonsurgical protocol for early stages of this disease were the patients with clinical and mri changes in the lunate but no clearcut kienbocks disease. Kienbocks disease is a progressive condition that affects the lunate bone in the wrist. It occurs when there is disruption in the blood supply to the lunate bone. Heres a look at the signs and symptoms, causes and treatment from your hand therapist. Kienbock disease is a condition characterized by avascular necrosis of the lunate bone. Its severity is graded 14, but not everyone goes through all 4 phases. Is from something called avascular necrosis, when the blood supply to the lunate diminished. Mri scan will show marrow changes consistent with avn. Mri protocoltendon pathologycarpal tunnel syndromeganglion cystacute traumaosteoarthritis.
Click to share on twitter opens in new window click to share on facebook opens in new window. Diffuse marrow signal alteration of the lunate bone seen displaying low signal on t1wis and t2wis. Findings, when present, depend on the morphological stage and include. It is breakdown of the lunate bone, a carpal bone in the wrist that articulates with the radius in the forearm. This signs and symptoms information for kienbock disease has been gathered from various sources, may not be fully accurate, and may not be the full list of kienbock disease signs. Softening, deterioration, fragmentation or compression of the affected bone can occur.
Other bones in the wrist can get a similar condition but theres no link between keinbocks and these other problems. Does kienbock disease spread to other bones to the wrist. Kelleys textbook of rheumatology ninth edition, 20. Epidemiology the age distribution for kienbock disease depends on gender. Mri is necessary in order to properly diagnose stage i, since it cannot be diagnosed by diagnostic radiography or ct alone. Msk mri protocols msk protocols msk mri protocols neuro protocols msk mri protocols body mri protocols 1. Kienbocks disease is a fairly rare condition affecting one of eight small carpal. Kienbock disease, lunatomalacia learning radiology. The symptoms of kienbock disease typically begin between the ages of 20 and 40 years with a 2. Kienbocks disease is a fairly rare condition affecting one of eight small carpal bones in the wrist, the lunate bone. Kienbock s disease is a progressive wrist disorder characterized by osteonecrosis of the lunate. This is a great reference book that is so far unique in the collection of mri books out there as a spiralbound havenexttothescanner book. Avascular necrosis of the lunate bone kienbock s disease. It has been defined as a specific form of osteonecrosis affecting the lunate bone of the carpus.
An mri scan is a more detailed scan that uses radio waves and a magnetic field to produce images that allows a physician to view any damage to the bones and soft tissue, surrounding the affected area. The treatment of kienbock s disease remains controversial, although numerous surgical procedures have been described 110. Contrastinduced mri is also useful for helping to figure out the degree of. The handbook of mri technique provides a guide to the operation of mr systems and to enhance the education of mr users. Although the main indication for arif of a distal radius fracture is an intraarticular stepoff of more than 1 mm, arthroscopy is particularly useful in the management of unstable or displaced intraarticular fractures as well as comminuted. These changes may produce pain, swelling, tenderness, thickening andor stiffness in the overlying tissues of the wrist. Kienbocks disease nyc wrist bone mri main street radiology. The lunate bone demonstrates decreased signal intensity on the. Kienbocks disease should be suspected when a young adult presents with pain and stiffness of the wrist and.
Magnetic resonance imaging mri is an important adjunct to diagnosis. Sometimes it gets better on its own or with some surgery. The injury may be a single incident, such as a sprain, or a repetitive trauma. Avascular necrosis of the lunate bone kienbocks disease. Substitute axial t1 for t2 gre if hardware is present.
We describe our protocol and a series of patients with evidence of lunate overload. Clinical musculoskeletal mri and protocol essentials. Kienbocks disease musculoskeletal medicine for medical. Operative treatment is based on the stage of the disease and may involve. Kienbock s disease is a rare and infrequently discussed source of wrist pain that you could definitely encounter in your clinical practice. It is not intended to be a clinical book as there are plenty of clinical specialist books on the market. Stage 3 of kienbocks disease showing collapse and possible fragmentation of the lunate bone. Advanced imaging can aid in the diagnosis and staging of kienbock disease. Kienbocks disease can eventually affect the structure and function of the wrist. Basic imaging and differential diagnosis of kienbocks disease. Youre also at an increased risk if you regularly do heavy manual labor. Sometimes the problem can be seen on a simple xray. Axial t1 and pd fs use coronal loc and plane is straight horizontal if the shoulder is markedly angled, you can angle the axial images.
Kienbocks disease is a condition in which the lunate bone, one of the small bones. Kienbocks disease is a condition characterized by interruption of blood supply to one of the small bones of the hand near the wrist the lunate. This book is distributed under the terms of the creative commons. Keinbocks disease replacement of fat signal cw avn.
It is important to get a clear history from the patient and examine the wrist very carefully. Kienbocks disease is a rare condition which affects the lunate bone in the wrist. The condition is named after the viennese radiologist robert kienbock who presented his findings on the disorder in his 1910 publication concerning traumatic malacia of the lunate and its consequences. The symptom information on this page attempts to provide a list of some possible signs and symptoms of kienbock disease.
Ct scanning, specialized ct scanning and bone scan may also be used. The appearance of imaging features of kienbocks disease mirrors the. Frontal view of the hand and wrist demonstrates sclerosis, irregularity and collapse of the lunate blue arrows. Doctors have not determined exactly what causes kienbocks disease. This book lists out the common pulse sequences for both. A hand therapy protocol for the treatment of lunate. The symptoms include wrist pain, limited range of motion, and decreased grip strength. Clinical musculoskeletal mri and protocol essentials kenneth buckwalter, md indiana university clarian health partners objective to demonstrate how various mri techniques can be optimized and combined to provide high quality images and yield clinically relevant diagnostic information. Kienbock disease refers to avascular necrosis of the lunate carpal bone, known. Most patients with kienbock s disease have the following symptoms. The disease commonly affects the dominant wrist, but bilateral disease can occur. Mri of a wrist with kienbocks disease showing loss of blood supply to the lunate. In particular, mri is helpful early in the disease when plain radiographs may not reveal abnormalities. The first five chapters of the book introduce the reader to the basics of mr imaging, including the relaxation concept, mr pulse sequences, and mr imaging parameters and options.
Kienboeck disease an overview sciencedirect topics. Guidelines for mr imaging of sports injuries european society of skeletal radiology sports subcommittee 2016 ara kassarjian, spain lars benjamin fritz, germany p. Pick sequences from total spine protocol not to be used with first time eval for drop mets to be used for brain tumor follow up where they are looking for only ax. These surgical methods have some disadvantages, such as large, invasive, and complicated procedures and uncertain lunate bone regeneration. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. Kienbock disease is the eponymous name given to osteonecrosis involving the lunate. Magnetic resonance imaging of the wrist wiley online library. A magnetic resonance imaging mri scan picks up very early changes in the lunate, even when the xrays are normal, and is the most sensitive test for this condition. Mor s n d thom asj ef r onu iv ty h p l mri of the wrist. The clinical onset can be abrupt or insidious, and the symptoms are nonspecific and can mimic oth er conditions, so it is important to ask about. Affected people may first think they have a sprained wrist and may have experienced trauma to the wrist, which can disrupt the blood flow to the. Kienbock s disease occurs most commonly in men between 20 and 40 years old. The next nearest book out there is handbook of mri technique, though this book is much more detailed in both sequences and specific anatomy areas.
Chapter in bookreportconference proceeding chapter. This bone is important for movement and stability in the wrist. Kienbocks disease genetic and rare diseases information. Kienbocks disease is a rare disease that affects the lunate of the wrist. Msk mri protocol overview page 3 of 123 msk mri protocols march 2010 1. It occurs when there is a disruption of the blood supply to the lunate bone. Other diseases, such as lupus, sickle cell anemia, cerebral palsy, and diseases that affect blood supply, are associated with kienbock s disease.