Kienbock's disease and scapholunate advanced collapse

Kienbock Disease: A Complicated Postsurgical Case Study Using Diagnostic Ultrasonography

OBJECTIVE

The purpose of this case report is to describe a case of Kienbock disease (lunatomalacia) that was identified through diagnostic ultrasonography.

CLINICAL FEATURES

A 27-year-old man presented to a chiropractic teaching clinic with a 3-year history of wrist pain. The history of chief concern consisted of lunatomalacia, diagnosed 2 years prior, with surgical intervention consisting of radial osteotomy and vascularized bone graft. Radiography and ultrasonography were performed upon presentation and at 2-year follow-up that demonstrated progressive collapse and fragmentation of his lunate with the development of progressive scapholunate advanced collapse of the wrist.

INTERVENTION AND OUTCOME

Conservative care included class IV cold laser and a splint worn during strenuous activity and while sleeping. The patient received minimal pain relief and continued to experience chronic left wrist pain. He is continuing conservative care and evaluating options for further surgical intervention.

CONCLUSION

This case demonstrates a patient with chronic wrist pain and progressive collapse of the lunate demonstrated on multiple imaging modalities after surgical intervention. To our knowledge, this is the first case demonstrating Kienbock disease using diagnostic ultrasonography.

Chronic Scapholunate Ligament Injury: Techniques in Repair and Reconstruction

Although the true incidence of scapholunate interosseous ligament (SLIL) injury is unknown, a study found that 35% of cadaveric wrists had some degree of scapholunate tear. Of those wrists with SLIL injury, 29% had evidence of arthrosis. Early recognition and treatment of these injuries can delay or prevent the onset of arthritis. This article details treatment options for SLIL injury across the spectrum of pathology with a particular emphasis on chronic scapholunate repair and reconstruction. New techniques and outcomes data also are presented.