周六接诊了一位月状骨无菌性坏死患者，也称Kienbock’s Disease ，临床上少见，但容易误诊误治，因此介绍给大家，与朋友分享！

腕关节是一神奇的关节，它有二排八块小骨头与掌骨、尺骨和桡骨组成。腕部这八块小骨头为手部的灵活、精巧而造，但也容易出现问题。月状骨无菌性坏死就是这种结构复杂的一个代价。

患者，29岁，印度人，去年年底，他感到右手腕疼痛，用力加重，去看医生，医生按一般损伤处理，给予止痛消炎药，介绍他去做理疗，无效果，反而加重，腕关节活动受限，上月去照X光，诊断为Kienbock’s Disease ，中文是月状骨无菌性坏死。

我曾治疗几例此病，但都半途而废，有始无终，没有治疗成功病例的经验，希望此患者能坚持治疗，成为我第一例针灸治疗月状骨无菌坏死成功病例。谢谢患者的信任！

月骨无菌性坏死的早期特有体征: 腕关节痛、腕背月骨区压痛伴有第三掌骨的轴向叩击痛和腕关节的功能障碍, 平均掌背屈活动度在80°左右; 手的握力下降, 平均为健侧的60 %。
临床上将本病分为四期：
(1)Ⅰ期仅表现为腕疼痛,尤以腕背伸时明显,X 线片无变化;
(2) Ⅱ期腕疼痛进一步加重,手的握力较健侧减低,X 线表现为月骨密度增高,骨小梁有不规则变化,但月骨形态正常;
(3)Ⅲ期表现为腕肿痛,疼痛可向前臂放射,腕背伸明显受限,X 线片表现月骨受压变扁,骨密度明显不均匀,但无骨碎块;
(4) Ⅳ期在Ⅱ、Ⅲ期病变的基础上合并有月骨碎块,偶伴有腕管综合征出现。

其病早期在X线片不能判断时，MRI能明确显示出缺血性改变。因此，MRI对于本病的早期诊断具有重要意义。

Case Study | Kienböck’s Disease — A Rare Cause of Persistent Wrist Pain

I recently saw a patient with a relatively uncommon wrist condition called Kienböck’s Disease, also known as avascular necrosis of the lunate.

It is not a condition that appears frequently in everyday practice, but it is important because the early symptoms can look very similar to a simple wrist sprain, overuse injury or tendon problem.

Patient History

The patient was a 29-year-old Indian man.

Toward the end of the previous year, he gradually developed pain in his right wrist.

The pain became worse when he used the hand or applied force through the wrist.

Initially, the problem was treated as a general wrist injury. He was given anti-inflammatory and pain medication and was referred for physiotherapy.

However, the symptoms did not improve.

Instead, the wrist pain gradually became worse and movement of the wrist became increasingly restricted.

The following month, further X-ray examination was performed.

This time, he was diagnosed with Kienböck’s Disease.

What Is Kienböck’s Disease?

The wrist contains eight small carpal bones arranged in two rows.

The lunate is one of the central bones in the proximal row and plays an important role in wrist movement and load transmission.

Kienböck’s Disease occurs when the blood supply to the lunate becomes impaired, leading to progressive changes in the bone.

In the early stages, symptoms may be relatively non-specific.

Patients may experience:

• pain over the back of the wrist;
• tenderness around the lunate region;
• reduced grip strength;
• pain when loading the wrist;
• and gradual loss of wrist movement.

Because these symptoms can resemble more common wrist problems, the diagnosis may be delayed.

Why Early Diagnosis Can Be Difficult

One of the challenges with Kienböck’s Disease is that early X-rays may still appear normal.

A patient may have persistent wrist pain and tenderness, yet the first plain radiograph does not clearly show the problem.

When clinical suspicion remains high, MRI can be particularly useful because changes in the lunate may be visible before obvious collapse appears on X-ray.

As the disease progresses, the lunate may become more sclerotic, lose height, collapse or fragment, and the surrounding wrist mechanics may also begin to change.

Clinical Staging

Kienböck’s Disease is commonly described using the Lichtman staging system.

In simplified terms:

Stage I:
X-rays may still appear normal, but MRI can show abnormal changes within the lunate.

Stage II:
The lunate becomes more sclerotic on X-ray, but its shape is still largely preserved.

Stage III:
The lunate begins to collapse. Depending on the stage, there may also be changes in the alignment of the surrounding carpal bones.

Stage IV:
More advanced structural change is present together with degenerative arthritis of the wrist.

The stage of the disease is important because treatment options differ significantly between early and advanced cases.

Treatment Considerations

Treatment is not determined by pain alone.

The patient’s age, disease stage, degree of lunate collapse, wrist alignment, cartilage condition, grip strength and functional demands all need to be considered.

Some early cases may initially be managed with activity modification, immobilisation and specialist monitoring.

More advanced disease may require surgical procedures aimed at reducing load on the lunate, improving blood supply, correcting wrist mechanics or addressing collapse and arthritis.

For this reason, Kienböck’s Disease should not simply be treated as a routine wrist strain.

Clinical Reflection

I had previously seen a few patients with this condition, but they had not completed long-term treatment and follow-up.

This case again reminded me of an important clinical principle:

when a common diagnosis does not behave like a common problem, the diagnosis should be reconsidered.

A wrist sprain or overuse injury should usually follow a reasonably predictable course.

If pain continues to worsen, grip strength declines or wrist movement becomes progressively restricted, it is important to think beyond soft-tissue injury.

The purpose of recognising Kienböck’s Disease early is not simply to give the condition a name.

It is to identify a structural problem before further collapse and degenerative change develop.

For an acupuncture practitioner, this is particularly important.

A patient may come asking for acupuncture, but the first responsibility is still to recognise when the presentation requires imaging, specialist assessment or surgical opinion.

Published on: Aug 13, 2018 at 19:26

Revised for Website 2.0: 14 November 2026