Kienbock's Disease in a Young Female without Classical Risk Factors: A Case Report with 1-year Functional Outcome...

Kienbock's disease is a rare and progressive condition characterized by avascular necrosis of the lunate, leading to chronic wrist pain, functional impairment, and eventual carpal collapse. Early diagnosis is often challenging due to non-specific clinical presentation and low sensitivity of initial radiographs.

A 29-year-old female presented with progressive left wrist pain and restricted movements for 6 months, without any history of trauma or classical risk factors. Clinical examination revealed localized tenderness and significant limitation of wrist mobility. Radiological evaluation with plain radiographs, computed tomography, and magnetic resonance imaging (MRI) confirmed avascular necrosis of the lunate, consistent with Lichtman stage IIIB disease.The patient underwent proximal row carpectomy (PRC) as a motion-preserving salvage procedure. Serial follow-up demonstrated progressive improvement in clinical and functional parameters. The disabilities of the arm, shoulder, and hand score improved from 62 preoperatively to 28 at 3 months, 15 at 6 months, and 8 at 1 year, while the Mayo Wrist Score improved from 45 (poor) to 65 (fair), 75 (good), and 85 (good) over the same period. At 1-year follow-up, the patient was pain-free at rest, with a satisfactory range of motion and return to daily activities.

Kienbock's disease should be considered in patients with persistent wrist pain, even in the absence of classical risk factors. Early MRI plays a crucial role in diagnosis and staging. PRC provides reliable pain relief and favorable functional outcomes in advanced stages, as demonstrated by sustained improvement over 1 year.