Kienböck's disease. I. Anatomy and Etiology.
Cumulative trauma disorders (CTD) pose a major industrial problem in terms of increased medical costs, lost productivity and degraded worker health and safety. From an anatomical view, CTD's are classified into three major categories: tendon disorders, neurovascular disorders and nerve disorders. Up until recently these categories seemed to cover CTD of the upper extremity, however, Kienböck's disease, a typically less common disease and one that does not fit into the established CTD categories, has been observed to exhibit CTD characteristics and does appear in the manufacturing environment. The most common types of employment observed to exhibit individuals with this disease are carpentry, jobs involving the use of pneumatic tools (wrench), spot welders, sheet metal work, farmers and factory workers. The present article makes a critical examination of the relevant anatomy and etiologic aspects of this disease.