Orthopedics Book


Navicular Avascular Necrosis

Aka: Navicular Avascular Necrosis, Kienbock's disease, Lunate AVN, Lunate Avascular Necrosis, Preiser's Disease, Navicular AVN, Carpal Avascular Necrosis
  1. Symptoms
    1. History of single major Wrist Injury
    2. History of multiple minor occupational injuries
    3. Chronic Wrist Pain, tenderness and swelling
    4. Restricted Wrist Range of Motion
      1. Dorsiflexion most often affected
  2. Signs: Passive dorsiflexion aggravates pain
    1. Pain middle finger dorsiflexion
      1. Kienbock's disease (Lunate Avascular Necrosis)
    2. Pain on index finger dorsiflexion
      1. Preiser's Disease (Navicular Avascular Necrosis)
  3. Radiology: Wrist XRay
    1. Initially: Normal
    2. Eventually: Involved bone dense, white, and sclerotic
    3. Later: Bone fragmentation and collapse occur
    4. End Result: Degenerative Arthritis
  4. Management
    1. Early stages
      1. Intermittent immobilization for months
      2. Allows reconstitution of normal bony architecture
      3. Cast removed on daily basis for ROM Exercises
    2. Later stages
      1. Surgery may be necessary

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