Advanced Kienbock’s Disease with Chronic Regional Pain Syndrome: A Case Report

Kienbock’s disease is a rare and painful disorder of the wrist, of unknown etiology, characterised by osteonecrosis of the lunate bone visible on wrist radiographs. It is typically seen in individuals aged 20-40 years, often in the dominant wrist, with a history of trauma. If left untreated, it can lead to fragmentation of the lunate, collapse and shortening of the carpus, and secondary arthritic changes throughout the proximal carpal area. We present a case of Kienbock’s disease Lichtman stage IV with Chronic Regional Pain Syndrome (CRPS) in a 53-year-old female who presented with right wrist pain and swelling persisting for one month, alongside a loss of range of motion of about 20 degrees in palmar and dorsal flexion, following a fall on an outstretched hand one year prior. Initially, the patient was managed conservatively with splinting, physiotherapy, and pharmacotherapy (Vitamin C, Vitamin D, Diclofenac) until the CRPS subsided. Subsequently, the patient underwent total wrist arthrodesis with bone grafting, resulting in pain relief and a satisfactory pain score.