Unusual Wrist Pain In A High School Running Back

HISTORY: Patient is a 15-year-old African-American male football player who presented to the clinic in July for evaluation of right wrist pain. His wrist pain began in January of 2023 but he felt that it had worsened the month prior to his visit. He reported being unable to lift weights or do push-ups during his workouts. Patient denied any history of trauma or injury to his right wrist, including when he first noticed the pain in January. He added that he was having trouble moving his wrist when carrying or catching a football on the right side. PHYSICAL EXAMINATION: He had tenderness to palpation over the proximal row of carpal bones on the right side. He also had severely limited range of motion in wrist flexion and extension due to pain. Left wrist range of motion was within normal limits. Strength was equal bilaterally despite pain in his right wrist during testing. Patient had no pain with manipulation of the distal radio ulnar joint bilaterally. Synergy testing, fovea sign, and reverse scoop testing were all negative bilaterally as well. DIFFERENTIAL DIAGNOSIS: Lunate fracture, scapholunate disruption, wrist sprain, carpal tunnel syndrome, and wrist extensor tendinitis TEST AND RESULTS: Radiographs of the right wrist demonstrated osteochondrosis of the lunate and a subtle lucency in the right scaphoid consistent with a prior injury to the scaphoid. Left wrist radiographs were normal. Subsequently, Kienbock's disease was added to the differential, and an MRI of the right wrist was ordered. His MRI demonstrated osteonecrosis with resorption of the lunate with adjacent chronic appearing erosive changes of the scaphoid and triquetrum. FINAL/WORKING DIAGNOSIS: Kienbock's disease of the right wrist TREATMENT AND OUTCOMES: Patient underwent definitive wrist partial denervation and right distal radius metaphyseal decompression osteotomy. He completed his therapy protocol post-operatively and was cleared for return to sport 10 weeks post procedure.