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Avascular necrosis of scaphoid
Other Resources UpToDate PubMed

Avascular necrosis of scaphoid

Contributors: Sophia Mavrommatis, Danielle Wilbur MD
Other Resources UpToDate PubMed

Synopsis

Preiser disease refers to idiopathic avascular necrosis of the scaphoid bone.

Causes / typical injury mechanism: Preiser disease is a rare condition with an unclear etiology. Possible causes for Preiser disease include:
Classic history and presentation: Preiser disease commonly manifests as chronic, radial-sided wrist pain. There is usually no identifiable trauma that precipitates this pain. Range of motion is typically limited, and grip strength is often reduced.

Prevalence:
  • Age – Preiser disease affects people of all ages but is typically diagnosed in middle-aged adults.
  • Sex / gender – Some evidence suggests that women are affected more than men.
Risk factors: Smoking, alcohol use disorder, infection, and a history of trauma to the region are all risk factors for Preiser disease.

Pathophysiology: The scaphoid has a retrograde blood supply and a poorly vascularized proximal pole. The limited vascularity of the scaphoid causes it to be particularly sensitive to occlusion, which can thus lead to avascular necrosis.

Grade / classification system:
Several classification systems exist.

Herbert-Lanzetta classification
This classification system grades Preiser disease based on the appearance of the scaphoid on plain radiographs. The stages are as follows:
  • Stage 1 – The plain radiograph is normal, but increased uptake is observed on bone scan.
  • Stage 2 – Increased density of the scaphoid's proximal pole.
  • Stage 3 – Fragmentation of the proximal pole of the scaphoid with or without pathologic fracture.
  • Stage 4 – Osteoarthritis and carpal collapse.
Kalainov classification
This classification system grades Preiser disease based on the scaphoid's appearance on MRI.
  • Type 1 – Involvement of the entire scaphoid.
  • Type 2 – Involvement of the proximal pole of the scaphoid.
Type 1 carries a worse prognosis than type 2.

Codes

ICD10CM:
M87.039 – Idiopathic aseptic necrosis of unspecified carpus

SNOMEDCT:
397758007 – Avascular necrosis of bone

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed:09/25/2022
Last Updated:11/09/2022
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Avascular necrosis of scaphoid
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