Clinical outcomes of nonsurgical treatment for Preiser disease

To elucidate whether nonsurgical treatment for Preiser disease is effective. Eight patients with Preiser disease (median age 59 [47–69] years ) underwent nonsurgical treatment (median symptom-onset-to-treatment interval 8 [9–180] months). At presentation, 7 patients complained of constant pain and 1 of motion-related pain. Pain restricted wrist range of motion (median modified Mayo wrist score [MMWS] 17.5 [range 10–30]). Radiography revealed stages 1 to 3 disease (Herbert–Lanzetta classification). Median scapholunate angle was 62° (54°–75°), with 3 wrists suffering dorsal intercalated segment instability (DISI). Magnetic resonance imaging showed (Kalainov criteria) 4 stage 1 wrists (complete necrosis) and 4 stage 2 (incomplete necrosis). Two had concomitant Kienböck disease. All patients underwent nonsurgical treatment (ie, oral pain killer, immobilization, rest) and were monitored via radiographic and clinical evaluations. Scapholunate angles and the scaphoid area reduction ratio were calculated using radiography. Response criteria were the patients’ subjective and objective status. Endpoint was the time from start of non-surgical to surgical treatment. Immobilization lasting 0 to 24 months (median 1.8 months) did not relieve their symptoms. Follow-up radiography showed that the disease stage had progressed in 5 of 8 wrists, with 5 wrists having DISI. The median area reduction ratio of the scaphoid was 11% (4%–52%) on anteroposterior views and 4% (−23% to 17%) on lateral views. Compared with the contralateral wrist, the median wrist flexion-extension arc was 61% (50%–79%) and the median grip strength 39%. Median MMWS score was 17.5 (10–25) – poor in 6 of 8 patients. Surgery was thus necessary in all patients. Nonsurgical treatment for Preiser disease did not improve subjective or objective outcomes and did not prevent deterioration of radiographic findings. Type of study/level of evidence: Therapeutic, Level V.