Long-term outcome of nonsurgically managed Kienbock's disease

Purpose: To analyze the natural history of patients with Kienbock's disease who did not have any surgical treatment-in effect, to map the pattern of the disease process. Methods: Thirty-three patients (33 wrists) with conservatively treated Kienbock's disease had a full clinical and radiologic review. The review involved an assessment of pain, range of motion, function, grip strength, and patient satisfaction, as well as a detailed radiologic evaluation. Results: Analysis of the results shows reduction in the range of motion of the wrist, particularly flexion, with progression of the disease process. In addition grip strength deteriorated by 40% between stages 2 and 4. The Disabilities of the Arm, Shoulder, and Hand evaluation system also showed deterioration between stages 2 and 4. Radiologic progression was best measured by the radioscaphoid angle. Conclusions: Kienbock's disease is progressive and does pass through the various stages described by Lichtman. Progression can be monitored clinically by the Disabilities of the Arm, Shoulder, and Hand score and the loss of flexion of the wrist. Radiologic progression is best measured by the radioscaphoid angle. Copyright (C) 2004 by the American Society for Surgery of the Hand.