title: Kienbock Disease: A Complicated Postsurgical Case Study Using Diagnostic Ultrasonography.
abstract: OBJECTIVE
  The purpose of this case report is to describe a case of Kienbock disease (lunatomalacia) that was identified through diagnostic ultrasonography.
  
  
  METHODS
  A 27-year-old man presented to a chiropractic teaching clinic with a 3-year history of wrist pain. The history of chief concern consisted of lunatomalacia, diagnosed 2 years prior, with surgical intervention consisting of radial osteotomy and vascularized bone graft. Radiography and ultrasonography were performed upon presentation and at 2-year follow-up that demonstrated progressive collapse and fragmentation of his lunate with the development of progressive scapholunate advanced collapse of the wrist.
  
  
  RESULTS
  Conservative care included class IV cold laser and a splint worn during strenuous activity and while sleeping. The patient received minimal pain relief and continued to experience chronic left wrist pain. He is continuing conservative care and evaluating options for further surgical intervention.
  
  
  CONCLUSIONS
  This case demonstrates a patient with chronic wrist pain and progressive collapse of the lunate demonstrated on multiple imaging modalities after surgical intervention. To our knowledge, this is the first case demonstrating Kienbock disease using diagnostic ultrasonography.
authors.affiliation: Diagnostic Imaging Resident, Department of Radiology, Logan University, St. Louis, Missouri.
authors.forename: Alicia M
authors.initials: AM
authors.lastname: Yochum
authors.affiliation: Chair, Department of Radiology, Logan University, St. Louis, Missouri.
authors.forename: Norman W
authors.initials: NW
authors.lastname: Kettner
keywords: Joint instability; Kienbock disease; Lunate; Ultrasonography