Kienbock's disease

(Robert Kienbock, 1871 - 1953, Austrian radiologist), osteochondritis of the lunate probably secondary to repetitive trauma. It is more common in adults but is occasionally seen in children, typically athletic adolescents and particularly gymnasts. The condition is often associated with shortening of the ulna, negative ulnar variance. The presenting complaint is usually pain, soft tissue swelling and stiffness.

Conventional radiographs will show irregular contour, fragmentation, sclerosis and collapse of the lunate. MR imaging shows initial decreased signal on T1- and increased signal on T2-weighted or STIR sequences reflecting oedema. Later there may be decreased signal or signal void on T1- and T2-weighted sequences reflecting bone death or sclerosis, this signal void may be limited to the mid body of the lunate. There may be an associated synovitis seen best on intravenous contrast-enhanced fat suppressed T1-weighted sequences.

HC