[Aetiology of Kienböck's Disease].
A definite pathogenesis for Kienböck's disease (KD) has not been identifed yet. Considering our clinical experience, mechanical factors, acute trauma or repetitive minor trauma seem to not be a primary cause, but rather factors that cause symptom aggravation of an already present KD. I feel we should look for a biological more than for a mechanical cause. Probably a vascular non-traumatic process, with a minor infarction pattern in the proximal subchondral area, is nearest to the truth. Bone remodelling results from bone resorption by osteoclasts and the formation of new bone by osteoblasts. Why osteoclast action should overpass the osteoblastic activity in the repair process is still not known. Studies of genes related to osteogenesis with polymerase chain reaction (PCR) arrays are a new option. Considering avascular necrosis as a possible reactive arthritis, PCR and viral RNA analysis could help in making the diagnosis.
Irisarri
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Centro Medico El Castro, Hand Unit, Vigo Pontevedra, Spain.
D016918:Arthritis, Reactive / Q000175:diagnosis / Q000503:physiopathology; D016723:Bone Remodeling / Q000502:physiology; D006801:Humans; D007238:Infarction / Q000175:diagnosis / Q000503:physiopathology; D012667:Lunate Bone / Q000098:blood supply; D010006:Osteoblasts / Q000502:physiology; D010010:Osteoclasts / Q000502:physiology; D010020:Osteonecrosis / Q000209:etiology*; D016133:Polymerase Chain Reaction; D012367:RNA, Viral / Q000032:analysis; D012307:Risk Factors
D012367:RNA, Viral