The Signal-Compromised Lunate

A wide spectrum of conditions can trigger signal alterations in the lunate bone. From vascular complications such as Kienböck's disease to axial microtrauma in ulnocarpal impaction syndrome, the lunate signal is an essential indicator of carpal health. Many of the pathologies described in this review rely on magnetic resonance imaging for analysis; however combined assessment of patient history, clinical symptoms, and imaging is often the only way to find the correct diagnosis. Standard radiography serves as the first-line modality for diagnostic assessment in most patients, but morphological analyses are more precise when based on high-resolution computed tomography imaging. Because gadolinium enhancement (not edema) is the deciding factor in the vitality assessment of the lunate, the imaging work-up of suspected osteonecrosis should include intravenous administration of contrast agent to discern viable tissue and so-called repair zones from entirely necrotic bone.