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Preiser’s Disease before(L) and one year after vascularized bone graft surgery.

What is Preiser Disease?

Preiser’s disease is avascular necrosis of the scaphoid bone. Avascular necrosis of the carpal bones is a rare condition and can affect the lunate, the pisiform, the capitate, and the scaphoid without a previous fracture. The condition develops with pain and occasional swelling around the anatomical snuffbox. It may be associated with loss of strength and reduced range of motion in the wrist.

Characteristics and Clinical Presentation of Preiser Disease

The clinical onset of idiopathic avascular necrosis of the scaphoid presents with increasing pain and stiffness in the wrist. An examination may reveal tenderness and swelling in the anatomy of the wrist. Patients may believe they have carpal tunnel syndrome and De Quervain’s syndrome, which resolve once Preiser Disease is treated.

Symptoms of Preiser Disease include:

  • Loss of strength
  • Swelling in snuffbox
  • Pain near the base of the thumb
  • Swelling near the base of the thumb
  • Difficulty moving your thumb and wrist when grasping or pinching

Causes of Preiser Disease

Avascular necrosis may occur without a previous history. Mild or repetitive trauma may be a contributing factor. Other known causes of avascular necrosis include steroid therapy, chemotherapy, and connective tissue diseases.

This condition can progress to carpal collapse and mid carpal
osteoarthritis after fragmentation.

Diagnosing Preiser Disease

Radiographic imaging is beneficial when scanning for evidence of sclerosis or fragmentation of the scaphoid. A magnetic resonance image scan can exclude osteonecrosis before surgery is considered. Early presentation may not reveal radiological abnormality. In these cases, bone scans may be helpful.

Treatment Options for Preiser Disease

Preiser’s disease is initially treated by immobilizing the wrist with a cast. Idiopathic avascular necrosis of the scaphoid is a progressive condition, which may the change treatment and prognosis depends on the stage the disease is diagnosed at. After a careful examination, Dr. Mark Pruzansky or Dr. Jason Pruzansky may recommend surgical or nonsurgical treatments.

Nonsurgical Treatments for Preiser Disease

In the early stages of Preiser disease, there is a possibility of reversing the pathological process.  In some cases, reconstruction may not be needed. The wrist can be treated with bracing, local cortisone injections, and oral analgesics.

Surgical Treatment Options for Preiser Disease

In the event that conservative countermeasures do not provide relief, it may be that the vascular scaphoid is collapsing.

There are two procedures commonly used to treat this condition:  

  • Proximal row carpectomy: Removal of the first row of the carpal bones (scaphoid, lunate and triquetrum).
  • Scaphoid excision and 4-corner fusion: Removal of the scaphoid. Remaining wrist bones are fixed with a plate or wires in order to provide stability.

Prognosis for Preiser Disease

The wrist is immobilized in a cast for 6 weeks after the surgery. Physical therapy is started after cast removal to restore mobility and range of function in the wrist. Many patients report relief in pain and tension immediately following their procedure.

If You Believe You Have Preiser Disease, Contact HandSport Surgery Institute

Please contact us as soon as possible to schedule an appointment with our talented team. People experiencing Preiser disease should be evaluated to try and prevent further injury and mobility issues.

If you have been injured, it’s important to be evaluated by a highly skilled professional. Call Drs. Mark and Jason Pruzansky at 212-249-8700 to schedule an appointment and obtain an accurate diagnosis.

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