Causes / typical injury mechanism: Preiser disease is a rare condition with an unclear etiology. Possible causes for Preiser disease include:
- Trauma or microtrauma
- Tobacco use
- Corticosteroid use
- Systemic diseases (eg, autoimmune hemolytic anemia, systemic lupus erythematosus, and post renal transplantation)
- Thumb hypoplasia
- 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.
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.
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.
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.