40 一位32歲果園工作婦女來門診主訴右腕疼痛已有近半年，理學檢查發現右腕背屈活動有明顯拘限，X光檢查如圖所示，最可能的診斷是：

正中腕隧症候群（carpal tunnel syndrome）

舟狀骨骨折不癒合（scaphoid fracture non-union）

半月狀骨缺血性壞死（Kienböck disease）

de Quervain’s tenosynovitis

kenbock disease

Specifically, Kienbock's disease is another name foravascular necrosis (death and fracture of bone tissue due to interruption of blood supply) with fragmentation and collapse of the lunate. This has classically been attributed to arterial disruption, but may also occur after events that produce venous congestion with elevated interosseous pressure.

Kienbock's disease is classified by features that indicate the severity of the problem.

1. Normal radiograph (possible lunate fracture).
2. Sclerosis of the lunate without collapse. (Portions of the lunate begin to deteriorate. This shows as a white blemish on x-rays.)
3. Lunate is completely dead. (The entire Lunate is dead. There is no living matter within the bone.)
4. Changes up to and including fragmentation, with superimposed arthritic changes.