Introduction

Semilunar avascular osteonecrosis/Kienböck’s disease has been associated with endogenous (ulnar negative variant and univocal vascularization) and/or extrinsic risk factors, such as prolonged exposure to vibrations and mechanical forces causing microtrauma.

Case report

The authors report a Kienböck disease case likely related to occupational hazards’ exposition. 44-year-old automechanic previously submitted to right wrist surgery in 2006 to pain relieve. Eight years after, he reports progressive worsening, especially upon active movement with incapacity for work and extreme limitation of daily life activities. He was evaluated by an orthophysiatric team who diagnosed Kienböck disease grade 3B according to Lichtman’s classification by magnetic resonance. He underwent semilunar arthroplasty, with tunneling of the flexor carpi radialis, but had to be reintervened six months after, due to scafolunar instability, with open ligamentoplasty with a graft from the extensor carpi radialis longus. Excision of the prosthesis and proximal row of the carpus was performed, due to persistent symptoms with functional limitation. Pain improvement at rest was observed but the worker maintained significant pain upon mobilization. Wrist arthrodesis was proposed, but the patient refused. Currently, he maintains absolute permanent incapacity for his usual work, despite a slight functional improvement under physiotherapy. Occupational disease was reported.

Discussion

Kienböck disease has a multifactorial pathophysiology so, as anatomical factors are hardly changeable, it’s crucial to adopt a preventive policy addressing potentially modifiable environmental aspects, as mechanical vibrations and/or microtrauma.

Conclusion

A careful clinical assessment, paying particular attention to critical anatomical structures, and controlling the mechanical hazards involved, helps to prevent/minimize the occurrence of injuries that can lead to profound implications on functionality and work capacity. Wrist image screening on workers exposed to physical/mechanical hazards or who manifest suggestive Kienböck disease’s symptoms, could help to avoid delayed diagnosis. Finally, the authors emphasize the importance of educating workers about occupational risk factors, as well as availability of personal protective equipment and providing training for its use.

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