What staging system is used for Kienböck disease?

Updated: Apr 26, 2021
  • Author: David M Lichtman, MD; Chief Editor: Harris Gellman, MD  more...
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Lichtman et al modified Stahl's original classification that consisted of four stages of Kienböck disease. [1, 53]  In this approach, the disease is staged as follows:

  • Stage I - Radiographic findings are negative except for possible fractures; bone scan findings are positive, indicating synovitis; MRI results are diagnostic; the patient's symptoms are consistent with a wrist sprain
  • Stage II - Radiographs reveal density changes of the lunate, and fractures may be present; later, posteroanterior (PA) radiographs may demonstrate loss of height on the radial side of the lunate; patients have recurrent pain and swelling
  • Stage III - The lunate has collapsed, and the capitate migrates proximally; scapholunate dissociation, flexion of the scaphoid, or ulnar migration of the triquetrum may occur; patients present with symptoms similar to those in individuals with stage II injuries, except that they often have increased wrist stiffness; stage III is divided into stage IIIA (lunate collapse without fixed scaphoid rotation) and stage IIIB (lunate collapse with fixed scaphoid rotation)
  • Stage IV - This stage includes all of the characteristics of stage III, as well as generalized degenerative changes in the carpus

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