[Natural course in lunate necrosis]

Reconstruction of the natural course of lunate necrosis is difficult because of incomplete findings, especially in the initial stages. The necrosis progresses steadily from initial lunate oedema with a normal X-ray appearance to condensation, fragmentation and collapse of the lunate within months. The collapse of the whole carpus means a dramatic deterioration in therapeutic possibilities not much later. In order to start treatment successfully in the initial stage, suspicious findings should be repeatedly followed up by X-ray films and magnetic resonance imaging. The development of degenerative changes often takes years. The clinical findings are not helpful in judging the course of the disease as pain varies and only the collapse of the lunate and late arthrosis accentuate pain.