Long-term natural outcome (7–26 years) of Lichtman stage III kienböck’s Lunatomalacia

Background and Aims:The natural history of Kienbock’s disease is controversial. Only three papers report a pure natural history without treatment. We hypothesized that the natural course of Kienbock’s disease may be better than reported.Material and Methods:We examined eight patients with Lichtman stage III Kienbock’s disease without any treatment, evaluating clinical and radiological results (9 wrists; 7 men, mean age at onset of symptoms 34 years) over a period of 10–38 years (mean, 27.3 years) after symptom onset.Results:Lichtman stage remained the same in five of nine wrists. The inner structure of the lunate improved in three, remained the same in three, and deteriorated in three wrists, and its shape improved in two, remained the same in four, and deteriorated in three wrists. Pain averaged visual analog scale 3.1 at rest, 3.4 during motion, 3.6 with slight, and 5.2 with heavy exertion. The range of motion improved at extension 19% and at flexion 14%, reaching 81% and 72% of that of the contralatera...