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Kienbock’s disease

Kienbock’s disease is an osteonecrosis (avascular necrosis) affecting the lunate of unknown etiology, affecting mostly young males aged 20–40 years. It is often associated with repeated minor wrist trauma.

It is sometimes associated with repeated minor wrist trauma.


Kienbock’s disease generally presents in adolescence or later with restricted range of motion in the wrist and loss of grip strength. Dorsal wrist pain is exacerbated by loading the wrist in extension.


Often there is a history of recurrent loading of the wrist, e.g., gymnastics, racquet sports, repetitive falls.

It is often associated with negative ulnar variance.

Left hand x-ray with Kienbock's Disease top view
Left hand x-ray with Kienbock's Disease top view

The classification system for Kienbock disease can help guide treatment, with stages 1 and 2 responding to rest and radial shortening if negative ulnar variance is present.


Treatment depends on the staging of the process, with stages 1 and 2 responding to rest and radial shortening if negative ulnar variance is present.


If diagnosed in the early stages before significant X-ray changes have occurred, rest from exacerbating activities and bracing or cast immobilization may prevent lunate collapse.

More advanced cases with lunate collapse, changes in carpal alignment, and/or wrist arthrosis require intercarpal arthrodeses, proximal row carpectomy (PRC), or wrist arthrodesis. Long-term disability is common after compressive changes have occurred.