Kienbock, Preiser-Case-Vignette

Case-Vignette

Pdf Summary

This case involves a 34-year-old woman with a 10-year history of right wrist pain. She has been wearing a wrist splint for 2 months with no relief. The physical exam reveals tenderness over the radial styloid and dorsal radiocarpal joint. Tests for snuffbox pain, CMC grind, and Finkelstein are negative. The patient has limited wrist flexion and extension. <br /><br />The next step in this case would be to consider treatment options. The diagnosis is not mentioned in the given text. Possible treatment options could include vascularized bone grafting or proximal row carpectomy. The patient's age may factor into the decision-making process. <br /><br />In terms of treatment, the patient could undergo vascularized bone grafting using the 4th and 5th ECA. Anterior and posterior interosseous nerves could be resected, and scaphocapitate pinning with the application of an external fixator could be done. If vascularized bone grafting fails, options such as lunate excision scaphocapitate fusion or proximal row carpectomy could be considered. <br /><br />For counseling the patient regarding her long-term prognosis, it is not mentioned in the given text. It is also not mentioned what the next step would be if the surgery were to fail. Different surgeons may have different preferences when it comes to treatment options and may reserve proximal row carpectomy for patients over 40 years of age.

Keywords

34-year-old woman

right wrist pain

wrist splint

radial styloid

dorsal radiocarpal joint

limited wrist flexion

limited wrist extension

treatment options

vascularized bone grafting

proximal row carpectomy