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Kienböck's Disease

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Kienböck’s disease — progressive wrist pain from lunate avascular necrosis; diagnosis and treatment options.

Updated Aug 2026
A hand-drawn illustration of the lunate carpal bone of the wrist losing its blood supply.
Advanced Kienböck's disease (Stage IIIB): the lunate bone in the centre of the wrist has lost its blood supply and collapsed, distorting the surrounding wrist mechanics. Kieran Hirpara 4.0

What you're feeling

You likely feel a steady ache in the center of your wrist. This pain comes from Kienböck disease, a condition where the lunate bone in your wrist loses its blood supply. Without enough blood, the bone weakens and can slowly collapse. You may notice the pain is deeper than a surface bruise. It often feels like it is coming from inside the joint itself.

The discomfort usually gets worse when you use your hand. Simple tasks like pushing up from a chair, lifting a grocery bag, or typing on a keyboard can trigger a sharp spike in pain. You might find that gripping objects becomes difficult. Turning a doorknob or holding a coffee cup may feel unstable or painful. Your wrist may also feel stiff, especially in the morning or after resting for a while. This stiffness can make it hard to move your hand freely at first.

Many patients report that the pain flares up at night. You might wake up because your wrist is throbbing or aching. This happens because the inflammation builds up when you are still. Resting the hand on a pillow may help slightly, but the pain often persists. Over time, you may notice a decrease in your grip strength. You might drop things more often or feel like your hand lacks power.

Because the condition is progressive, these symptoms tend to worsen if left untreated. The bone changes can lead to arthritis in the wrist joint. This wear-and-tear arthritis causes further pain and stiffness. You may feel a grinding sensation when you move your wrist. While the natural history of this disease is not fully known, it generally progresses through stages. Early detection is key to managing these symptoms effectively. Your surgeon will use imaging to see how much the bone has changed. This helps determine the best path forward to relieve your pain and restore function.

What's actually happening

Your wrist contains eight small bones called carpals. In Kienböck’s disease, one of these bones, the lunate, loses its blood supply. Think of the lunate as a central shock absorber in your wrist. Without blood, the bone tissue begins to die and soften. It can no longer handle the daily pressure of your movements.

As the lunate weakens, it starts to collapse. This changes how all the other wrist bones move together. Normally, these bones glide smoothly like gears in a machine. When the lunate collapses, the movement becomes uneven. The other bones shift out of their normal alignment. This misalignment causes friction and stress on the surrounding joints.

This structural change is what leads to your pain and stiffness. The irregular motion irritates the joint surfaces. Over time, this wear-and-tear can lead to arthritis in nearby areas. Your surgeon sees these changes on scans to understand the stage of the disease.

In younger patients, the bones are still growing. Your surgeon may use a radial osteotomy to adjust the angle of your forearm bone. This takes pressure off the lunate and helps it heal. For older patients or those with more advanced collapse, other options exist. We might use a vascularized bone graft to bring new blood supply to the dying bone.

If the bone has already collapsed significantly, we may consider a scaphocapitate arthrodesis. This procedure fuses two adjacent bones together. It creates a stable, solid block that stops the painful grinding motion. While this reduces some wrist flexibility, it provides long-term pain relief and strength.

In some cases, we might shorten the capitate bone. This simple adjustment helps realign the wrist column. It can restore function in the earlier stages of the disease. The goal is always to restore balance to your wrist mechanics. We aim to reduce pain and keep your hand functional for as long as possible.

What we can do about it

Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, approaches this condition by matching the treatment to the stage of your disease. Patients reach our clinic by GP or physiotherapist referral. A clinic assessment, including history, examination, and imaging where needed, establishes the diagnosis. For degenerative or long-standing problems, we usually try non-operative care first. This includes activity changes, physiotherapy or hand therapy, splinting, and injections. We consider surgery when this has not given enough improvement. For structural or acute problems, surgery may be recommended straight away, without a preceding non-operative trial.

In the early stages, your wrist may respond well to self-management and physiotherapy. Our goal is to reduce stress on the lunate bone and maintain movement. You might use a splint to rest the wrist and avoid activities that cause pain. Physiotherapy focuses on gentle exercises to keep the joint mobile and strengthen the surrounding muscles. Good and excellent clinical and radiological outcomes can be achieved with these nonsurgical treatments in skeletally immature patients. We typically advise giving this approach a fair trial before considering more invasive options.

Medical management helps control symptoms while we monitor the disease. Pain medication and anti-inflammatories can reduce discomfort and swelling. Injections, such as cortisone, may provide temporary relief by calming inflammation in the joint. While evidence for other injections like hyaluronic acid or PRP is less defined for this specific condition, we discuss all options with you. The natural history of Kienböck's disease is generally considered a progressive condition that can end in Stage IV changes. However, radiographic progression of Kienböck over 1 year or more seems slight on average regardless of treatment. We monitor your progress with regular X-rays to ensure the condition remains stable.

When conservative care has reached its limit, or if the disease is advanced, surgery is considered. Surgical treatment focuses on biomechanical unloading, vascularized bone grafts, or salvage procedures depending on the stage. For example, radial shortening osteotomy provides decade-long improvement in 75% of patients. Vascularized bone grafting for stage III Kienböck disease demonstrates favorable long-term results. Scaphocapitate arthrodesis is an effective procedure for treatment of collapsed Kienböck disease, offering significant improvement in pain scores and grip strength. We present these options as a shared decision, ensuring you understand the benefits and limitations of each path.

What to expect

Kienböck’s disease is a condition where the blood supply to a small wrist bone breaks down. This causes the bone to weaken and eventually collapse. Without treatment, the condition typically progresses over time. It often leads to wear-and-tear arthritis in the wrist joint. The natural history of this disease is not fully known, but it generally tends to worsen rather than settle on its own.

With treatment, the outlook improves significantly. Your surgeon can offer several options depending on the stage of your disease. For younger patients, bone realignment procedures often improve symptoms and X-ray findings in the short term. For more advanced cases where the bone has collapsed, procedures that fuse nearby bones together provide long-term benefits. These surgeries aim to stop the collapse and reduce pain.

Many patients experience lasting relief. For example, radial shortening osteotomy provides decade-long improvement in 75% of patients with symptomatic Kienböck’s disease. Other procedures, such as scaphocapitate arthrodesis with lunate excision, show significant pain relief and preserved mobility at a mean follow-up of 10.7 years. Proximal row carpectomy is also a durable option for advanced disease, maintaining wrist motion and grip strength at an average follow-up of 10 years.

Even with treatment, the disease does not always progress rapidly. Radiographic progression over one year or more is slight on average, regardless of the treatment chosen. This means your wrist structure may remain stable for a considerable time after surgery. However, you should expect some period of adjustment as your wrist heals and strengthens.

If left untreated, the condition may lead to Stage IV changes, which involve severe arthritis. This can result in chronic pain and limited function. Early intervention helps preserve your wrist’s natural movement and strength. Your surgeon will discuss which approach best fits your specific anatomy and lifestyle needs. The goal is to manage pain and maintain your ability to use your hand for daily tasks.

When to see someone

Kienböck’s disease is a rare condition affecting the wrist bones. It usually gets worse over time, though the exact path is not fully known. See your GP if you have persistent pain that does not improve with rest. Ask for a specialist review if you notice weakness, instability, or if your wrist locks or gives way. Seek help if symptoms interfere with your sleep or work, or if you experience a sudden worsening. Early assessment is important because bone shape and wrist alignment can influence severity. Your surgeon will use imaging to check for changes, as standard X-rays may not always show early collapse clearly.

Reviewed by Kieran Hirpara · 27 April 2026.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

Overview

  • Radial osteotomies are effective in improving short-term clinical outcomes and radiographic findings in teenage patients with Kienböck disease [1].
  • Scaphocapitate arthrodesis demonstrates long-term clinical benefits for the treatment of collapsed Kienböck disease [2].
  • Vascularized bone grafting for stage III Kienböck disease demonstrates favorable long-term results and is recommended as a surgical treatment [3].
  • Good and excellent clinical and radiological outcomes can be achieved with both nonsurgical and surgical treatments in skeletally immature patients with Kienböck disease [5].
  • Temporary scaphotrapezoidal joint fixation is recommended for the surgical treatment of adolescent Kienböck's disease [7].
  • Radial shortening osteotomy provides decade-long improvement in 75% of patients and is a reasonable treatment for symptomatic Kienböck’s disease [8].
  • Scaphocapitate arthrodesis is an effective procedure for the treatment of Kienböck disease, associated with satisfactory functional outcomes and significant improvement in pain scores and grip strength [13].
  • Capitate shortening is a safe and effective approach for the treatment of early stages of Kienböck's disease and can be associated with a satisfying outcome [14].
  • Advanced Kienböck's disease with carpal collapse is not a contraindication for carpal-sparing surgery radial shortening osteotomy [17].
  • Lunate excision, capitate osteotomy, and intercarpal arthrodesis should be used with caution for advanced Kienböck's disease because it does not have good long-term results and is no longer widely used in Europe [25].
  • The acceptance rate for negative outcomes studies regarding Kienböck's disease is higher than for other surgical disorders, indicating a relative decrease in positive outcome bias among published Kienböck's disease studies compared with other surgical disorders [41].

Anatomy & Pathophysiology

  • Tendon ball arthroplasty and proximal carpal stabilization with tendon graft restore the integrity of the proximal carpal row in advanced Kienböck’s disease [28].
  • Surgical treatments for scapholunate advanced collapse result in decreased wrist kinematic motion and functional performance compared with individuals with normal wrists [30].
  • Lunate morphology affects the 3-dimensional kinematics of the carpus during wrist flexion and extension [31].
  • Three- and 4-corner fusions produce motion that is smoother and more closely replicates the normal axis and functional motion of the wrist [32].
  • Computed fiber elongations of the dorsal carpal ligaments vary linearly with wrist position [33].
  • Four-dimensional computed tomography (4DCT) is a non-invasive and affordable method to assess and quantify wrist kinematics by incorporating the temporal dimension [34].
  • During simple unresisted wrist motions, force in the scapholunate interosseous ligament does not exceed 20 N [35].
  • Kinematic changes in scapholunate instability may predict the development of radioscaphoid arthritis and help identify a kinematically abnormal wrist [36].
  • Rotational malalignment of the wrist has significant effects on carpal, distal radial, and distal radioulnar joint measurements [37].
  • Scaphoid nonunions have a dramatic impact on carpal kinematics by partially uncoupling the proximal and distal carpal rows [42].
  • Dynamic imaging may enable the derivation of a standardized protocol for mapping carpal motion that is clinically applicable and reproducible [44].
  • Computer-aided CT analysis provides guidelines for measuring and quantifying carpal alignment three-dimensionally and establishes a database for normal values [45].
  • More than half the motion of the carpus when the wrist was loaded in extension occurred at the midcarpal joint [47].
  • Radioscapholunate fusion shows the most biomechanically similar behavior to the healthy wrist among three fusion types [51].
  • Contact areas between the scaphoid and distal radius are maximized during full extension of the wrist, which helps stabilize the radiocarpal joint [52].
  • A dorsally applied PLA plate restores carpal kinematics for 1,000 cycles of motion in unstable wrists where fixation is not compromised by carpal size or osteoporosis [53].
  • The modification of the wrist center of rotation during flexion and extension indicates that stability is considered more important than mobility in clinical conditions [54].
  • Correction of scapholunate dissociation may correlate with improved carpal dynamics and improved clinical outcomes [56].
  • Postarthroscopic lunate excision alters normal carpal kinematics but maintains joint congruity in the short-term [57].

Classification

  • Kienböck disease is generally considered a progressive condition that can end in Stage IV changes [6].
  • Lunate morphology may affect the severity of Kienböck disease at the time of initial presentation [9].
  • The patterns of carpal collapse differ between stage IIIb Kienböck disease and scapholunate dislocation in terms of radioscaphoid joint congruity [50].
  • Traditional radiographic indices measured on plain radiographs have poor diagnostic performance in the detection of carpal collapse in Kienböck's disease [15].

Clinical Presentation

  • Kienböck disease is a relatively infrequent carpal pathology [4].
  • Kienböck disease is generally considered a progressive condition that can end in Stage IV changes [6].
  • The natural history of Kienböck disease is not fully known [6].
  • Lunate morphology may affect the severity of Kienböck disease at the time of initial presentation [9].
  • The development of Kienböck disease is probably multifactorial [10].
  • Traditional radiographic indices measured on plain radiographs have poor diagnostic performance in the detection of carpal collapse in Kienböck's disease [15].

Investigations

  • Radial osteotomies are effective in improving short-term clinical outcomes and radiographic findings in teenage patients with Kienböck disease [1].
  • Scaphocapitate arthrodesis demonstrates long-term clinical benefits for the treatment of collapsed Kienböck disease [2].
  • Vascularized bone grafting for stage III Kienböck disease demonstrates favorable long-term results and is recommended as a surgical treatment [3].
  • Good and excellent clinical and radiological outcomes can be achieved with both nonsurgical and surgical treatments in skeletally immature patients with Kienböck disease [5].
  • Temporary scaphotrapezoidal joint fixation is recommended for the surgical treatment of adolescent Kienböck's disease [7].
  • Radial shortening osteotomy provides decade-long improvement in 75% of patients and is a reasonable treatment for symptomatic Kienböck’s disease [8].
  • Lunate morphology may affect the severity of Kienböck disease at the time of initial presentation [9].
  • Traditional radiographic indices measured on plain radiographs have poor diagnostic performance in the detection of carpal collapse in Kienböck's disease [15].
  • The Camembert osteotomy improved function in patients with early stage Kienböck disease, with MRI aspects improving in most cases and no patients experiencing lunate collapse [21].
  • Radiographic progression of Kienböck over 1 year or more seems slight on average regardless of treatment [26].
  • Computed tomography of the lunate in Kienböck disease is an important investigative tool [43].
  • Lunates with advanced Kienböck's disease exhibit significantly denser, thicker, and more plate-like trabecular microstructure compared to normal lunates [58].
  • Following medial femoral trochlea reconstruction of the proximal lunate for advanced Kienböck disease, cessation of radiocarpal collapse was observed [59].

Treatment

Non-Operative and General Considerations

  • Good and excellent clinical and radiological outcomes can be achieved with both nonsurgical and surgical treatments in skeletally immature patients with Kienböck disease [5].
  • The natural history of Kienböck's disease is generally considered a progressive condition that can end in Stage IV changes [6].
  • Treatment strategies for Kienböck's disease focus on biomechanical unloading, vascularized bone grafts, or salvage procedures depending on the stage [6].
  • There is limited, low-quality evidence that surgical treatment slows progression of Kienböck's disease [18].
  • Many uncontrolled case series document slight improvement in motion and grip after surgical treatment without clear evidence that this is better than placebo or no intervention [18].

Radial Osteotomies and Shortening

  • Radial osteotomies are effective in improving not only short-term clinical outcomes, but also radiographic findings in teenage patients with Kienböck disease [1].
  • Radial shortening osteotomy provides decade-long improvement in 75% of patients and seems to be a reasonable treatment for symptomatic Kienböck’s disease [8].
  • The medium- and long-term results of radial shortening osteotomy for Kienböck's disease in patients with negative ulnar variance are comparable to short-term results, providing long-lasting pain relief [16].
  • Advanced Kienbock's disease with carpal collapse is not a contraindication for carpal-sparing surgery radial shortening osteotomy [17].
  • Radius core decompression demonstrated favorable long-term results and could be considered as a surgical alternative for stage IIIA of Kienböck disease [61].

Vascularized Bone Grafts

  • Vascularized bone grafting for stage III Kienböck disease demonstrated favorable long-term results and is recommended as a surgical treatment [3].
  • Vascularized bone grafts are indicated for Kienböck's disease, while being contraindicated in advanced carpal collapse with degenerative changes [40].

Arthrodesis and Salvage Procedures

  • The long-term clinical benefits of scaphocapitate arthrodesis for treatment of collapsed Kienböck disease are demonstrated [2].
  • Scaphocapitate arthrodesis is an effective procedure for treatment of Kienböck disease associated with satisfactory functional outcomes and significant improvement in pain scores and grip strength [13].
  • Scaphocapitate arthrodesis should be considered as a treatment option for wrist salvage in the patient with advanced Kienbock's disease given the significant postoperative reduction in associated pain symptoms at the time of follow-up [24].
  • Scaphotrapeziotrapezoid arthrodesis with lunate excision for advanced Kienböck disease provided favorable clinical results in terms of pain relief and functional improvement [22].
  • The procedure of lunate excision, capitate osteotomy, and intercarpal arthrodesis should be used with caution for advanced Kienböck's disease because it does not have good long-term results and is no longer widely used in Europe [25].
  • Improved outcomes following proximal row carpectomy were associated with Kienbock's disease [55].

Capitate Shortening

  • Capitate shortening is a safe and effective approach for treatment of the early stages of Kienböck's disease and can be associated with a satisfying outcome [14].

Arthroscopic Procedures

  • Arthroscopic lunate core decompression appears to be an effective and safe surgery for treating Kienböck disease on the basis of mid-term follow-up [20].

Adolescent-Specific Interventions

  • Temporary scaphotrapezoidal joint fixation is recommended for the surgical treatment of adolescent Kienböck's disease [7].

Complications

  • Kienböck's disease is generally considered a progressive condition that can end in Stage IV changes [6].
  • The natural history of Kienböck's disease is not fully known [6].
  • Lunate morphology may affect the severity of Kienböck disease at the time of initial presentation [9].
  • Negative ulnar variance has a longitudinal relationship with progressive Kienböck disease, though additional long-term study is needed to confirm this [19].
  • The development of Kienböck disease is probably multifactorial [10].
  • The observation of Kienböck disease and carpal coalition in one wrist is fortuitous [10].

Recovery

  • Radial osteotomies improve short-term clinical outcomes in teenage patients with Kienböck disease [1].
  • Radial osteotomies improve radiographic findings in teenage patients with Kienböck disease [1].
  • Scaphocapitate arthrodesis provides long-term clinical benefits for collapsed Kienböck disease [2].
  • Vascularized bone grafting demonstrates favorable long-term results for stage III Kienböck disease [3].
  • Radial shortening osteotomy provides decade-long improvement in 75% of patients with symptomatic Kienböck’s disease [8].
  • Radial shortening osteotomy provides long-lasting pain relief for patients with negative ulnar variance [16].
  • Titanium lunate arthroplasty (TLA) shows promising longer-term results for stage III Kienböck disease [23].
  • Scaphocapitate arthrodesis with lunate excision significantly alleviates pain in advanced Kienböck disease at a mean follow-up of 10.7 years [38].
  • Scaphocapitate arthrodesis with lunate excision preserves functional mobility in advanced Kienböck disease at a mean follow-up of 10.7 years [38].
  • Scaphocapitate arthrodesis with lunate excision maintains satisfactory grip strength in advanced Kienböck disease at a mean follow-up of 10.7 years [38].
  • Proximal row carpectomy (PRC) is a durable long-term treatment option for radiocarpal degenerative arthritis and Kienböck's disease [46].
  • Proximal row carpectomy allows for maintenance of wrist range of motion [46].
  • Proximal row carpectomy improves grip strength [46].
  • Proximal row carpectomy is a reliable and durable procedure for Lichtman stage IIIA or IIIB Kienböck's disease at an average follow-up of 10 years [49].
  • Scaphocapitate arthrodesis (SCA) results in improved grip strength in patients with advanced stages of Kienböck disease in medium-term follow-up [48].
  • Scaphocapitate arthrodesis (SCA) corrects carpal alignment in patients with advanced stages of Kienböck disease in medium-term follow-up [48].
  • Radiographic progression of Kienböck disease over 1 year or more is slight on average regardless of treatment [26].

Key Evidence

  • [L4] The current results indicate that radial osteotomies are effective in improving not only short-term clinical outcomes, but also radiographic findings in teenage patients with Kienböck disease. [1] (10.1097/01.blo.0000173254.46899.72)
  • [L4] The long-term clinical benefits of scaphocapitate arthrodesis for treatment of collapsed Kienböck disease are demonstrated. [2] (10.1177/1753193413496177)
  • [L3] Vascularized bone grafting for stage III Kienböck disease demonstrated favorable long-term results and is recommended as a surgical treatment. [3] (10.1016/j.jhsa.2013.02.010)
  • [L5] This review article discusses the history, etiology, and course of Kienböck disease and reviews the literature on both the diagnosis and management of this relatively infrequent carpal pathology. [4] (10.5435/jaaos-d-20-00020)
  • [L4] Good and excellent clinical and radiological outcomes can be achieved with both nonsurgical and surgical treatments in skeletally immature patients with Kienböck disease. [5] (10.1016/j.jhsa.2018.02.029)
  • [L5] The natural history of Kienbock's disease is not fully known, though it is generally considered a progressive condition that can end in Stage IV changes; treatment strategies focus on biomechanical unloading, vascularized bone grafts, or salvage procedures depending on the stage. [6] (10.1016/j.hcl.2006.07.003)
  • [L4] We therefore recommend this procedure for the surgical treatment of adolescent Kienböck's disease. [7] (10.1016/j.jhsa.2008.09.019)
  • [L4] Radial shortening osteotomy provides decade-long improvement in 75% of patients and seems to be a reasonable treatment for symptomatic Kienböck’s disease. [8] (10.1177/1753193413512222)
  • [L3] Lunate morphology may affect the severity of Kienböck disease at the time of initial presentation. [9] (10.1016/j.jhsa.2014.12.024)
  • [Letter] The observation of Kienböck disease and carpal coalition in one wrist is fortuitous, and the development of Kienböck disease is probably multifactorial. [10] (10.1016/j.jhsa.2016.11.010)
  • [L4] Scaphocapitate arthrodesis is an effective procedure for treatment of Kienböck disease associated with satisfactory functional outcomes and significant improvement in pain scores and grip strength. [13] (10.1016/j.jhsg.2023.03.014)
  • [L2] Capitate shortening is a safe and effective approach for treatment of the early stages of Kienböck's disease and can be associated with a satisfying outcome. [14] (10.1177/15589447221081564)
  • [L3] Traditional radiographic indices measured on plain radiographs have poor diagnostic performance in the detection of carpal collapse in Kienböck's disease. [15] (10.1177/17531934231153966)
  • [L3] The medium- and long-term results of radial shortening osteotomy for Kienböck's disease in patients with negative ulnar variance are comparable to short-term results, providing long-lasting pain relief. [16] (10.1097/blo.0b013e318041d309)
  • [L5] There is limited, low-quality evidence that surgical treatment slows progression of Kienböck's disease, and many uncontrolled case series document slight improvement in motion and grip after surgical treatment without clear evidence that this is better than placebo or no intervention. [18] (10.1016/j.jhsa.2009.10.013)
  • [L2] Additional long-term study is needed to confirm the longitudinal relationship of negative ulnar variance with progressive Kienböck disease. [19] (10.1016/j.jhsa.2017.06.107)
  • [L4] Arthroscopic lunate core decompression appears to be an effective and safe surgery for treating Kienböck disease on the basis of mid-term follow-up. [20] (10.1016/j.jhsa.2023.02.011)
  • [L4] Scaphotrapeziotrapezoid arthrodesis with lunate excision for advanced Kienböck disease provided favorable clinical results in terms of pain relief and functional improvement. [22] (10.1016/j.jhsa.2012.08.031)
  • [L4] The longer-term results of TLA for stage III Kienböck disease are promising. [23] (10.1016/j.jhsa.2018.02.009)
  • [L4] Given the significant postoperative reduction in associated pain symptoms at the time of follow-up, scaphocapitate arthrodesis should be considered as a treatment option for wrist salvage in the patient with advanced Kienbock's disease. [24] (10.1007/s11552-014-9705-z)
  • [L5] The procedure of lunate excision, capitate osteotomy, and intercarpal arthrodesis should be used with caution for advanced Kienböck's disease because it does not have good long-term results and is no longer widely used in Europe. [25] (10.1177/1753193418807360)
  • [L4] Radiographic progression of Kienböck over 1 year or more seems slight on average regardless of treatment. [26] (10.1016/j.jhsa.2016.02.016)
  • [L4] The technique demonstrated reduced wrist pain and improved wrist motion and grip strength while restoring the integrity of the proximal carpal row. [28] (10.1177/17531934241238939)
  • [L2] Both surgical groups demonstrated decreased wrist kinematic motion and functional performance compared with individuals with normal wrists. [30] (10.1016/j.jhsa.2015.04.035)
  • [L5] This study describes the effect of lunate morphology on 3-dimensional carpal kinematics during wrist flexion and extension. [31] (10.1016/j.jhsa.2014.09.019)
  • [L3] Motion was smoother and more closely replicated the normal axis and functional motion of the wrist. [32] (10.1016/j.jhsa.2015.02.027)
  • [L5] Despite complex carpal bone anatomy and kinematics, computed fiber elongations were found to vary linearly with wrist position. [33] (10.1016/j.jhsa.2012.04.025)
  • [L5] Four-dimensional computed tomography (4DCT) is a promising, non-invasive, and affordable method to assess and quantify wrist kinematics, extending conventional CT by incorporating the temporal dimension. [34] (10.1177/17531934251326028)
  • [L5] However, during simple unresisted wrist motions, the force did not exceed 20 N. [35] (10.1016/j.jhsa.2015.04.007)
  • [L3] These kinematic changes may predict the development of radioscaphoid arthritis and help identify a kinematically abnormal wrist. [36] (10.1177/17531934241242676)
  • [L4] Rotational malalignment of the wrist has significant effects on carpal, distal radial and distal radioulnar joint measurements. [37] (10.1177/1753193408090393)
  • [L4] Scaphocapitate arthrodesis with lunate excision performed in an advanced stage of Kienböck disease significantly alleviates pain, while preserving functional mobility and satisfactory grip strength in the long term. [38] (10.1177/1753193417739247)
  • [L4] This manuscript offers a current review of the techniques and outcomes of VBGs to the carpal bones, noting that VBGs are indicated for scaphoid nonunion with proximal pole AVN, Kienböck's disease, Preiser's disease, and capitate osteonecrosis, while being contraindicated in advanced carpal collapse with degenerative changes. [40] (10.1007/s11552-012-9479-0)
  • [L2] The acceptance rate for negative outcomes studies regarding Kienböck's disease is higher than for other surgical disorders, indicating a relative decrease in positive outcome bias among published Kienböck's disease studies compared with other surgical disorders. [41] (10.1016/j.jhsa.2009.12.003)
  • [L4] Scaphoid nonunions have a dramatic impact on carpal kinematics, partially uncoupling the proximal and distal carpal rows. [42] (10.1016/j.jhsa.2008.03.008)
  • [L4] Computed tomography of the lunate in Kienböck disease is an important investigative tool. [43] (10.1016/j.jhsa.2018.05.008)
  • [L4] With the increased focus on dynamic imaging for wrist motion, it may be possible to derive a standardized protocol for mapping the carpal motion that is clinically applicable and reproducible. [44] (10.1016/j.jhsg.2022.10.001)
  • [L4] This study provides guidelines on how to measure and quantify carpal alignment three-dimensionally and establishes a database for normal values, which may be useful when analysing various wrist pathologies and kinematics. [45] (10.1177/17531934231160100)
  • [L4] PRC is a durable long-term treatment option for radiocarpal degenerative arthritis and Kienböck's disease allowing for maintenance of wrist range of motion and improvement in grip strength. [46] (10.1016/s0363-5023(10)60087-1)
  • [L4] More than half the motion of the carpus when the wrist was loaded in extension occurred at the midcarpal joint. [47] (10.1016/j.jhsa.2012.10.035)
  • [L4] SCA resulted in improved grip strength with correction of carpal alignment in patients with advanced stages of Kienböck disease in medium-term follow-up. [48] (10.1016/j.jhsa.2014.12.013)
  • [L4] At an average follow-up of 10 years, proximal row carpectomy is a reliable and durable procedure for patients with Lichtman stage IIIA or IIIB Kienböck's disease. [49] (10.1016/j.jhsa.2008.02.031)
  • [L2] The patterns of carpal collapse differed between stage IIIb Kienböck disease and scapholunate dislocation in terms of radioscaphoid joint congruity. [50] (10.1016/j.jhsa.2014.10.035)
  • [L5] The contact areas between the scaphoid and distal radius are maximized during full extension of the wrist, which helps stabilize the radiocarpal joint and potentially reduces the risk of injury to the carpus and the distal radius. [52] (10.1177/1753193413507810)
  • [L5] The study shows that in the unstable wrist, following ligament sectioning, where fixation is not compromised by carpal size or osteoporosis, a dorsally applied PLA plate does restore carpal kinematics for 1,000 cycles of motion. [53] (10.1016/j.jhsa.2008.01.016)
  • [L4] The study also characterized the modification of the wrist CoR during flexion and extension, noting that stability is considered more important than mobility in clinical conditions. [54] (10.1016/s0749-0712(03)00008-8)
  • [L3] Improved outcomes were associated with age over 40, Kienbock's disease, concomitant neurectomy, non-labourer status, and surgery after 1990, while radiocapitate arthrosis did not correlate with clinical outcomes. [55] (10.1177/1753193415597096)
  • [L5] This correction might correlate with improved carpal dynamics and improved clinical outcomes. [56] (10.1016/j.jhsa.2010.06.029)
  • [L4] Although postarthroscopic lunate excision alters normal carpal kinematics, the joint congruity is maintained in the short-term. [57] (10.1016/j.jhsa.2025.01.024)
  • [L4] Lunates with advanced Kienböck's disease exhibit significantly denser, thicker, and more plate-like trabecular microstructure compared to normal lunates. [58] (10.1177/1753193411422337)
  • [L4] Following medial femoral trochlea reconstruction of the proximal lunate for advanced Kienböck disease, we observed a cessation of radiocarpal collapse. [59] (10.1016/j.jhsa.2019.12.008)
  • [L4] In this limited series, the radius core decompression demonstrated favorable long-term results and could be considered as a surgical alternative for stage IIIA of Kienböck disease. [61] (10.1016/j.jhsa.2017.05.017)

References

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