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synonyms: osteonecrosis scaphoid. avascular necrosis scaphoid
Preiser's Disease ICD-10
Preiser's Disease ICD-9
- 733.40 (Aseptic necrosis of bone, site unspecified)
Preiser's Disease Etiology / Epidemiology / Natural History
- Definition: osteonecrosis of the scaphoid.
- Etiology unknown
Preiser's Disease Anatomy
- Proximal pole is completely intraarticular and recieves blood supply from distal pole
- Superficial palmar branch of radial A volarly & dorsal capsal branch of radial A dorsally(80%)
Preiser's Disease Clinical Evaluation
- Wrist pain, swelling, decreased ROM
- Snuffbox tenderness
- Scaphoid tubercle tenderness
- Pain c axial loading of 1st metacarpal
Preiser's Disease Xray / Diagnositc Tests
- PA, Lateral, Scaphoid views of the wrist. Xrays may be normal initially, but progress iwth sclerosis and later fragmentation and collapse of the scaphoid and wrist arthritis.
- CT scan: demonstrates the amount of fragmentation
- MRI: helpful for determining vascularity.
Preiser's Disease Classification / Treatment
- Stage I: partial osteonecrosis; no collapse, no adjacent arthritic changes.
Treatment:vascularized bone grafting.
- Stage II: complete osteonecrosis; collapse +/- adjacent arthritic changes.
Treatment: intercarpal fusion, scaphoid excision with intercarpal fusion or Proximal row carpectomy.
Preiser's Disease Associated Injuries / Differential Diagnosis
- Scaphoid fracture
- Scaphoid nonunion
- Keinbock's disease
- Ulnocarpal impaction syndrome
Preiser's Disease Complications
- Degenerative changes in adjacent articulations.
- Stiffness, motion loss.
- Weakness.
- CRPS
- Continued pain.
- Instability.
Preiser's Disease Follow-up Care
- Post-op: Volar splint in neutral, elevation.
- 7-10 Days: Wound check, short arm cast.
- 4 Weeks: Cast removed, xray wrist. Start gentle ROM / strengthening exercises. Functional activities. Cock-up wrist splint prn / for light duty work. No heavy manual labor
- 3 Months:Full activities, may resume manual labor if adequate strength has been achieved.
- 6 Months:
- 1Yr: fo,,ow-up xrays, assess outcome
Preiser's Disease Review References
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