Avascular necrosis of the carpal lunate: a case report

A case is presented of avascular necrosis of the carpal lunate (Kienböck's disease). Orthopedic findings included marked decrease in ranges of motion in all directions and marked decrease in grip strength. Radiographic findings revealed increased density of the lunate, along with evidence of rotation. Conservative therapy of immobilization, ultrasonic and galvanic currents was later followed by orthopedic surgery. This case clearly demonstrates the importance of a team approach to the management of a problem of this sort and the importance of proper and timely diagnosis and treatment in order to prevent chronic disability of the wrist. Initial management of this case consisted of conservative treatment to alleviate pain and swelling. Surgery further alleviated pain and provided increased ranges of motion of flexion, extension and ulnar deviation and grip strength. Movement of radial deviation did not improve at this time. The goal of postsurgical conservative (rehabilitative) therapy, designed to provide satisfactory ranges of movement in all directions and grip strength, was expected to be reached.