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Preiser's Disease M87.00 733.40

synonyms:

 

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, Scaphoidviews 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

Greens Hand Surgery

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