Long-Term Natural Outcome (7-26 Years) of Lichtman Stage III Kienböck's Lunatomalacia

The natural history of Kienböck's disease is controversial. Only three papers report a pure natural history without treatment. We hypothesized that the natural course of Kienböck's disease may be better than reported.

We examined eight patients with Lichtman stage III Kienböck's disease without any treatment, evaluating clinical and radiological results (9 wrists; 7 men, mean age at onset of symptoms 34 years) over a period of 10-38 years (mean, 27.3 years) after symptom onset.

Lichtman stage remained the same in five of nine wrists. The inner structure of the lunate improved in three, remained the same in three, and deteriorated in three wrists, and its shape improved in two, remained the same in four, and deteriorated in three wrists. Pain averaged visual analog scale 3.1 at rest, 3.4 during motion, 3.6 with slight, and 5.2 with heavy exertion. The range of motion improved at extension 19% and at flexion 14%, reaching 81% and 72% of that of the contralateral wrist, and grip strength reaching 93%. The Disabilities of the Arm, Shoulder, and Hand averaged 11.3, Optional Disabilities of the Arm, Shoulder, and Hand 18.0, and Mayo Clinic score 70.0. The radiographic course did not correlate with clinical course.

The long-term natural history of Lichtman stage III Kienböck's disease is insufficiently good to suggest thoughtful observation alone as an option to treat it.