Kienböck's disease: insidious unilateral wrist pain.

To cite: Davidson DJ, Anakwe RE. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2014205189 DESCRIPTION Kienböck’s disease (KD) is characterised by avascular necrosis of the lunate bone and is of unknown aetiology. KD is thought to result from a combination of vascular, anatomic and traumatic insults resulting in interruption of the blood supply to the lunate and osteonecrosis. A 58-year-old retired engineer presented with a 20-year history of right wrist pain, swelling and decreased function. Examination revealed tenderness over the dorsal lunate, decreased wrist flexion-extension arc and decreased grip strength. KD is more common in men and rarely affects bilateral wrists. The symptoms of KD are insidious and easily mistaken for a minor wrist injury. Early disease may appear normal on plain radiographs with pathological change only evident on MRI. Our patient’s radiographs demonstrated a sclerotic fragmented lunate with loss of lunate height (figure 1) and CT imaging determined that the radiocarpal and intercarpal joints were relatively well preserved (figure 2).