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Bone and Spine

Orthopedic health, conditions and treatment

Preiser Disease or Avascular Necrosis of Scaphoid

By Dr Arun Pal Singh

In this article
    • Classification
    • Clinical Presentation
      • Imaging
      • Treatment
      • Preiser Disease Complications

Preiser disease is the term for idiopathic avascular necrosis of the scaphoid bone. Preiser disease was described by Preiser in 1910.

It is a rare disease that affects the patients in their forties.

Avascular necrosis of the carpal bones is rare. It is mostly seen in the lunate, the pisiform, the capitate, and the scaphoid.

MRI image of Preiser

The diagnosis is based on radiographic evidence of sclerosis and fragmentation of the proximal pole of the scaphoid.

Preise disease is mostly unilateral but can occur in both scaphoids too.

It is mandatory in all cases of scaphoid nonunion to exclude osteonecrosis by MRI scans before surgery is undertaken.

Classification

Type 1

  • Complete
  • Poor outcome

Type 2

  • Partial or segmental
  • Better outcome

Clinical Presentation

Patients with Preiser disease present with wrist pain on radial-side. The onset of the pain is insidious and may worsen with time.

On examination, there would be swelling and tenderness around the dorsoradial aspect of the wrist. There would be a restriction of range of motion and grip strength.

Imaging

The early presentation may not reveal any radiological abnormality. In cases with clinical suspicion and normal radiographs, a bone scan is helpful.

Changes in the xrays would depend on the stage of the disease.

Herbert and Lanzetta classification

ed the stages of Preiser disease according to the radiographic appearance.

Stage I

Normal radiographs, positive bone scan.

Stage II

Increased density of proximal pole, generalized osteoporosis.

Stage III

Fragmentation of proximal pole. There could be presence of a pathological fracture.

Stage IV

Carpal collapse, osteoarthritis.

Treatment

Nonoperative treatment consists of immobilization and is effective in about 20% of cases.

Operative treatment 

  • Microfracture drilling, revascularization procedure, or allograft
  • Proximal row carpectomy or scaphoid excision with four corner fusion

The latter is a type of salvage procedure.

considered salvage procedures

Treatment options for Preiser disease include

Arthroscopic debridement and drilling of the lesion is a minimally invasive technique that seems to provide pain relief for a long period of time in patients with Preiser’s disease and can be employed initially along with conservative measures like rest, splintage, and electrical stimulation.

For vascularized bone graft, the graft is harvested from distal radius dorsally or volarly in the form of a pronator quadratus graft, or from the second metacarpal.

Preiser Disease Complications

  • Degenerative changes
  • Stiffness
  • Weakness of wrist
  • Complex Regional Pain Syndrome
  • Continued pain
  • Wrist instability
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Filed Under: Hand and Upper Limb

About Dr Arun Pal Singh

Arun Pal Singh is an orthopedic and trauma surgeon, founder and chief editor of this website. He works in Kanwar Bone and Spine Clinic, Dasuya, Hoshiarpur, Punjab.

This website is an effort to educate and support people and medical personnel on orthopedic issues and musculoskeletal health.

You can follow him on Facebook, Linkedin and Twitter

Reader Interactions

Comments

  1. Stephanie Riddle says

    January 17, 2017 at 1:46 am

    I have Preiser’s Disease, stage 4 in my wrists. I would like to know if this is in the rest of my joints. Some of the nurses and physical therapists believe that it is also in my shin bone and other joints. I have needed my knees replaced for a very long time due to my age at the time. I am at the age where we thought it would be best wait, 60, and I am afraid that I have waited to long and there is damage in the bone and can’t have a knee replacement. Is this disease going to go into all the joints of the body or just the joints that have had trauma or just the wrists and the other joints will just be arthritis?

  2. Dr Arun Pal Singh says

    January 25, 2017 at 11:53 am

    Stephanie Riddle,

    Preiser Disease, as a term is used for avascular necrosis of scaphoid. From your symptoms, you seem to have some generalized disorder.

    Are we talking about something else?

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