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A Case of Delayed Steroid-Induced Kienböck's Disease
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Posted on: 09/14/2006
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Loss of blood supply to a bone with subsequent death of the bone is called avascular necrosis. When it affects the lunate bone of the wrist, it's called Kienböck's disease. The most common risk factors for this condition are trauma, steroids, smoking, and alcoholism.
Dr. Jeffrey Budoff from Baylor College of Medicine (Texas) presents this case report of a 50-year old woman with both Kienböck's and Preiser's diseases of the right wrist. Preiser's disease is a condition of osteonecrosis of the carpal scaphoid, another bone in the wrist.
The patient presented with decreased motion and constant pain. Both symptoms interfered with daily activities. Her past medical history included taking steroids 11 years ago for viral pneumonia, asthma, and a kidney cyst. She reported smoking two packs of cigarettes a day. There was no known trauma to the wrist or hand.
The patient tried a course of conservative care without change in her symptoms. Surgery was planned to retain some motion of the wrist. Instead of fusing the wrist, the surgeon removed the first row of carpal (wrist) bones. A flap of soft tissue was used to fill in the gap.
Results were good. The patient reported at least a 50 per cent decrease in her pain and an increase in wrist motion. At the follow-up three years after the surgery, she had functional wrist motion. Her main symptom was soreness with activities but reported it was "tolerable."
The purpose of this case report was to alert surgeons that patients can have more than one carpal bone affected by osteonecrosis. This can happen without the usual risk factors. In this case, a delay of 11 years after steroid use or unrecognized trauma was probably the cause of both Kienböck's and Preiser's disease of the wrist.
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References:
Jeffrey E. Budoff, MD. Concomitant Kienböck's and Prieser's Diseases: A Case Report. In The Journal of Hand Surgery. September 2006. Vol. 31A. No. 7. Pp. 1149-1153.
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