Lunate Malacia
| Classification according to ICD-10 | |
|---|---|
| M92.2 | Juvenile osteochondrosis of the hand - Juvenile osteochondrosis of the lunate bone of the wrist (Kienböck disease) |
| ICD-10 online (WHO version 2019) | |
The lunatomalacia (syn. Mondbeinnekrose, Kienbock disease) is the degree of destruction ( necrosis ) of the lunate in the wrist. It has been known for a long time, but could only be anatomically assigned with the discovery of X-rays . It was first described in 1910 by the Austrian radiologist Robert Kienböck (1871–1953), after whom the disease is named in the Anglo-American language area. It belongs to the group of aseptic bone necrosis .
Emergence
There is no reliable theory on the pathogenesis of lunate malacia. The following factors are discussed as favoring factors:
- Stress fracture with consecutive devascularization, when the lunate is mainly supplied by a single artery coming from the volar / palmar.
- recurrent microtraumas of the wrist due to long-term work with a pneumatic hammer
course
The necrosis develops without any particular pain and can go undetected for years. Pain in the extensor side of the proximal wrist leads to an X-ray examination, which enables a visual diagnosis. The magnetic resonance imaging and computed tomography are not necessary. A loss of strength in the affected hand and significant movement restrictions of the wrist can develop.
Orthoses to immobilize the wrist can be useful. In addition, various surgical therapy methods can be used. In exceptional cases - pain with severe signs of wear and tear in the wrist - surgical stiffening ( arthrodesis ) of the wrist or the proximal carpal bones can be considered.
Web links
- GI Bain et al .: The Etiology and Pathogenesis of Kienböck Disease. In: Journal of wrist surgery. Volume 5, Number 4, November 2016, pp. 248-254, doi : 10.1055 / s-0036-1583755 , PMID 27777813 , PMC 5074830 (free full text).
- Kienböck's Disease: Advances in Diagnosis and Treatment (2016)
- Kienbock's Disease (RUSH 2016)
