title: Long-term outcome of nonsurgically managed Kienböck's disease.
abstract: OBJECTIVE
  To analyze the natural history of patients with Kienböck's disease who did not have any surgical treatment-in effect, to map the pattern of the disease process.
  
  
  METHODS
  Thirty-three patients (33 wrists) with conservatively treated Kienböck's disease had a full clinical and radiologic review. The review involved an assessment of pain, range of motion, function, grip strength, and patient satisfaction, as well as a detailed radiologic evaluation.
  
  
  RESULTS
  Analysis of the results shows reduction in the range of motion of the wrist, particularly flexion, with progression of the disease process. In addition grip strength deteriorated by 40% between stages 2 and 4. The Disabilities of the Arm, Shoulder, and Hand evaluation system also showed deterioration between stages 2 and 4. Radiologic progression was best measured by the radioscaphoid angle.
  
  
  CONCLUSIONS
  Kienböck's disease is progressive and does pass through the various stages described by Lichtman. Progression can be monitored clinically by the Disabilities of the Arm, Shoulder, and Hand score and the loss of flexion of the wrist. Radiologic progression is best measured by the radioscaphoid angle.
authors.affiliation: Northwest Hand Group, Wrightington Hospital, United Kingdom, Wigan, Lancashire, UK.
authors.forename: Prue P A
authors.initials: PP
authors.lastname: Keith
authors.forename: David
authors.initials: D
authors.lastname: Nuttall
authors.forename: Ian
authors.initials: I
authors.lastname: Trail
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002348:Carpal Bones / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000145:classification / Q000503:physiopathology / Q000628:therapy*; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D013997:Time Factors