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One of the most popular treatment algorithms for Kienböck disease is based on a progression of successive radiographic changes that was developed in the 1970s. Since then, 2 other important classifications systems have been introduced. One is centered on contrasted magnetic resonance imaging findings and the other, articular cartilage degeneration. All 3 systems have been used, in isolation, to recommend specific treatment modalities. To coordinate all available clinical data and to simplify the treatment selection process, we combined the 3 classification systems into 1 unified classification and treatment algorithm. With the added consideration of some recently introduced surgical options and further knowledge of how Kienböck disease affects children and the elderly, we anticipate that this unified classification system will allow for a more precise and individualized treatment plan.

The purpose of this study was to determine whether a standardized hand activity would produce changes in the cross-sectional diameter of the median nerve. Ultrasound measures of proven reliability of the cross-sectional diameter of the median nerve in the wrist were taken. These measures were taken before activity and immediately after the activity, after 5 minutes, and after 10 minutes. The median nerves of 40 normal subjects showed an increase in cross-sectional diameter immediately after hand activity then returned to a size close to the preactivity size within 10 minutes. The cross-sectional area of the carpal canal did not change significantly after the hand activity was performed. Female gender and body mass index over 25 were associated with significantly larger size increases in the median nerve. This preliminary study suggests that ultrasound is sensitive to the effects of activity upon the hand.