Disclosures: Jason Lew, DO: No financial relationships or conflicts of interest

Case Diagnosis: 36-year-old male with history of spastic diplegic cerebral palsy who presents with spasticity to his left wrist, diagnosed with Kienböck’s disease.

Case Description or Program Description: A 36-year-old male with history of spastic diplegic cerebral palsy who presents with spasticity to his left wrist. He previously only had spasticity to his bilateral lower extremities and had not noticed any in his upper extremities. This started insidiously about six months prior without any inciting trauma or injury. Patient was referred to physiatry for potential Botox injections. He had spasticity in his left wrist flexors with a modified Ashworth Scale score of 1+, as well as mild focal tenderness at the dorsal aspect of his wrist. This was accompanied by objective decreased grip strength and reduced range of motion at his wrist in all planes.

Setting: Outpatient Physiatry Clinic

Assessment/Results: A hand x-ray was performed and revealed osteonecrosis of the lunate consistent with Kienböck’s disease. He was placed in a volar splint and referred to orthopedics for surgical consultation.

Discussion (relevance): Kienböck’s disease is caused by loss of blood supply to the lunate resulting in avascular necrosis. There has been research into the increased prevalence of Kienböck’s disease in cerebral palsy, although this is more often seen in dystonic quadriplegia leading to flexed positioning of the wrist which decreases blood supply to the lunate. Another proposed mechanism is negative ulnar variance, which is more common in cerebral palsy patients and may cause increased stress on the lunate.

Conclusions: This case demonstrates a patient with new spasticity as the primary presenting symptom in Kienböck’s disease. Although cerebral palsy has some correlation with Kienböck’s disease, this patient did not previously have increased wrist tone or negative ulnar variance which are risk factors for Kienböck’s disease. A heightened level of suspicion for Kienböck’s disease should be present in cerebral palsy patients with wrist spasticity or pain.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/spasticity-as-presenting-symptom-of-kienbocks-disease-in-a-cerebral-palsy-patient/