A 24 year old man with chronic wrist pain

 

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Doctor's Information

Name : Maryam
Family :Noori
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : ----------------

 

Patient's Information

Gender : Male
Age : 24

 

Case Section

Muskuloskeletal System

 

Clinical Summary

A 24-year-old man with chronic wrist pain.

 

 

Imaging Procedures and Findings

A 24-year-old man was further evaluated about chronic wrist pain & tenderness. Performed MRI showed marrow hypointensity with some collapse of lunate on T1w & bone marrow hyperintensity on T2w indicative for avascular necrosis of lunate (kienbockâ??s disease); also ulnar minus variance more than 1mm is depicted. One month later CT scan showed some degree of collapse & fragmentation indicative for a Lichtman stage IV (sclerosis, collapse & radiocarpal arthrosis) AVN of lunate.

 

Discussion

70% of patients have ulnar minus variance greater than 1 mm and 95% are involved in manual labor. More common in males and patients are usually in the 20 to 40-year age group. Management may be conservative or surgical depending on the stage of disease. Lichtman and Degnan described radiographic staging. Stage I Iunates are normal radiographically but may have signal intensity abnormalities on MRI. In patients with stage II disease, there is increased density or sclerosis in the lunate without collapse. Stage III demonstrates collapse and fragmentation. Stage IV disease includes features of stage III plus radiocarpal arthrosis.

 

Final Diagnosis

Kienbock's disease

 

References

Diagnostic Imaging Orthopedics, David W. Stoller. MD. FACR, Phillip F.J. Tirman. MD, Miriam A. Bredella. MD, et al. MRI of the MusculoskeletalSystem. Thomas H. Berquist, MD, FACR.

 

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