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Kienbocks Disease

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Other Names

  • Avascular Necrosis of the Lunate
  • Osteonecrosis of the lunate
  • Kienbock's Disease
  • Kienbock Disease
  • Lunatomalacia


  • This page refers to Kienbock's disease, or avascular necrosis of the Lunate


  • Named after Viennese radiologist Robert Kienbock, who termed it lunatomalacia (need citation)


  • Poorly described in the literature
  • Affects dominant hand of men between age 20 - 40 (need citation)


  • General
    • Disease of unclear etiology resulting in avascular necrosis or osteonecrosis of the carpal Lunate
    • Ulnar variance leads to scaphoid exhibiting excessive loads across the lunate
    • Can lead to progressive wrist pain, abnormal carpal motion

Risk Factors

  • Negative ulnar variance
  • History of trauma
  • Occupational Risk factors
    • Manual laborer
    • Repetitive loading occupations

Differential Diagnosis

Clinical Features

  • History
    • Patients report dorsal wrist pain
    • Decreased wrist motion and grip strength
    • Patients may endorse a history of or have clinically swelling and tenderness at the radiocarpal joint
    • Worse with activity
    • Dominant hand more commonly affected
  • Physical Exam: Physical Exam Wrist
    • Tenderness along the lunate, radiocarpal joint
    • Swelling may or may not be present
    • Decreased range of motion in flexion/extension of wrist
    • Decreased grip strength


Patient number 3, left wrist, Stage IIIa Kienböck's disease in 1992. B) the same wrist in 2012, 20 years later, still at Stage IIIa.[1]



  • Useful for staging
    • Especially once Lunate collapse has occurred
  • Useful for describing
    • Extent of necrosis
    • Trabecular destruction
    • Lunate geometry


  • Valuable in early disease staging
  • Findings
    • Decreased T1 signal intensity
    • Reduced lunate vascularity


Lichtman Classification

  • Based upon radiographs
  • Stage I - Normal radiograph (however changes seen on MRI)
  • Stage II - Increased radiodensity or sclerosis of lunate
  • Stage IIIa - Lunate collapse, no scaphoid rotation
  • Stage IIIb - Lunate collapse, fixed scaphoid rotation
  • Stage IV - Degenerative changes around the lunate




  • Indications
    • Surgery indicated for Stage II - IV
  • Technique[2]
    • Temporary scaphotrapeziotrapezoidal pinning
    • Joint leveling procedure
    • Radial wedge osteotomy
    • Vascularized bone grafts
    • Distal radius core decompression
    • Partial wrist fusions
    • Proximal row carpectomy (PRC)
    • Wrist fusion
    • Total wrist arthroplasty

Rehab and Return to Play


  • Needs to be updated

Return to Play/ Work

  • Unknown, no clear guidelines

Complications and Prognosis


  • Progressive, debilitating if not recognized and treated appropriately (need citation)


  • Radiocarpal arthritis

See Also


  1. Viljakka, T., K. Tallroth, and M. Vastamäki. "Long-Term Natural Outcome (7–26 Years) of Lichtman Stage III Kienböck’s Lunatomalacia." Scandinavian Journal of Surgery 105.2 (2016): 125-132.
  2. https://www.orthobullets.com/hand/6050/kienbocks-disease
Created by:
John Kiel on 30 June 2019 20:51:40
Last edited:
13 October 2022 21:49:29