Kienböck's Disease: A Rare Case Report and Review of Management

Kienböck's disease (KD) is a rare condition characterized by avascular necrosis of the lunate, ultimately causing progressive wrist dysfunction and pain. Here, we present a case of a 26-year-old woman with persistent left wrist pain refractory to conservative treatment. Physical examination revealed tenderness over the lunate with diminished sensation in the ulnar and median nerve distribution. However, nerve conduction studies showed normal nerve function, ruling out carpal tunnel syndrome. Various imaging modalities revealed lunate sclerosis, edema, and ulnar negative variance, strongly indicative of KD. In this case, the patient decided to undergo a left distal radius shortening osteotomy to alleviate lunate compression and restore vascular perfusion. This case report highlights the multifactorial nature of KD, including anatomical, vascular, occupational, and genetic risk factors. Additionally, this case emphasizes the importance of tailoring treatment modalities based on disease severity as outlined by the Lichtman classification system. Given the limited literature on KD and the absence of standardized treatment guidelines, further research is necessary to optimize treatment strategies and improve clinical outcomes.