Activity-related Pain Research Articles

Outcome following mini-open lower limb fasciotomy for chronic exertional compartment syndrome

PurposeThe aim of this study was to report outcomes following mini-open lower limb fasciotomy (MLLF) in active adults with chronic exertional compartment syndrome (CECS).MethodsFrom 2013–2018, 38 consecutive patients (mean age 31 years [16–60], 71% [n = 27/38] male) underwent MLLF. There were 21 unilateral procedures, 10 simultaneous bilateral and 7 staged bilateral. There were 22 anterior fasciotomies, five posterior and 11 four-compartment. Early complications were determined from medical records of 37/38 patients (97%) at a mean of four months (1–19). Patient-reported outcomes (including EuroQol scores [EQ-5D/EQ-VAS], return to sport and satisfaction) were obtained via postal survey from 27/38 respondents (71%) at a mean of 3.7 years (0.3–6.4). ResultsComplications occurred in 16% (n = 6/37): superficial infection (11%, n = 4/37), deep infection (3%, n = 1/37) and wound dehiscence (3%, n = 1/37). Eight per cent (n = 3/37) required revision fasciotomy for recurrent leg pain. At longer-term follow-up, 30% (n = 8/27) were asymptomatic and another 56% (n = 15/27) reported improved symptoms. The mean pain score improved from 6.1 to 2.5 during normal activity and 9.1 to 4.7 during sport (both p < 0.001). The mean EQ-5D was 0.781 (0.130–1) and EQ-VAS 77 (33–95). Of 25 patients playing sport preoperatively, 64% (n = 16/25) returned, 75% (n = 12/16) reporting improved exercise tolerance. Seventy-four per cent (n = 20/27) were satisfied and 81% (n = 22/27) would recommend the procedure.ConclusionMLLF is safe and effective for active adults with CECS. The revision rate is low, and although recurrent symptoms are common most achieve symptomatic improvement, with reduced activity-related leg pain and good health-related quality of life. The majority return to sport and are satisfied with their outcome.

Patient experiences with physiotherapy for knee osteoarthritis in Australia—a qualitative study

ObjectivePhysiotherapists commonly provide non-surgical care for people with knee osteoarthritis (OA). It is unknown if patients are receiving high-quality physiotherapy care for their knee OA. This study aimed to explore...

The Influence of Specific Bioactive Collagen Peptides on Knee Joint Discomfort in Young Physically Active Adults: A Randomized Controlled Trial.

First evidence indicates that the supplementation of specific collagen peptides is associated with a significant reduction in activity-related joint pain in young adults. The purpose of the current investigation was to confirm the efficacy of the same collagen peptides in a comparable study population. In total, 180 active men and women aged between 18 and 30 years with exercise-related knee pain but no diagnosed joint disease completed the trial over a period of 12 weeks. Participants were randomly assigned to the group receiving 5 g of specific collagen peptides (CP-G) or to the placebo group (P-G). For the primary outcome, changes in pain during or after exercise from pre- to post-intervention were assessed by the participants using the Visual Analog Scale (VAS). These changes were additionally evaluated by the examining physician by means of anamnesis and physical examination of the affected knee joint. As secondary outcomes, pain under resting conditions and after 20 squats were compared between the study groups. In addition, the mobility of the knee joint and the use of alternative therapies (e.g., ointments or physiotherapy) were recorded. The supplementation of specific collagen peptides derived from type I collagen with a mean molecular weight of 3 kDa led to a significantly (p = 0.024) higher reduction of exercise-induced knee pain (−21.9 ± 18.3 mm) compared with the placebo group (−15.6 ± 18.5 mm). These findings were consistent with the physician’s evaluation (−23.0 ± 19.2 mm vs. −14.6 ± 17.9 mm, p = 0.003). The decrease in pain under resting conditions and after squats did not significantly differ between the groups, as only a small number of participants suffered from pain under these conditions. Due to the clinically unremarkable baseline values, the mobility of the knee joint did not change significantly after the intervention. In conclusion, the current investigation confirmed that the oral intake of bioactive collagen peptides used in the current investigation led to a statistically significant reduction of activity-related joint pain in young active adults suffering from knee joint discomfort.

Patterns of Approach to Activity in 851 Patients With Severe Chronic Pain: Translation and Preliminary Validation of the 9-item Avoidance-Endurance Fast-Screen (AEFS) Into Danish.

The Avoidance-Endurance Fast-Screen (AEFS) is a 9-item self-report questionnaire that classifies patients with back pain into 4 activity-related subgroups, based on the Avoidance-Endurance Model of pain. The objective of this study was to translate the AEFS into Danish and investigate its discriminative abilities in a large, diverse patient sample. A total of 851 specialist care-seeking patients with severe chronic pain conditions participated in this cross-sectional study. Participants were categorized as showing a "distress-endurance" (DER), "eustress-endurance" (EER), "fear-avoidance" (FAR), or "adaptive" (AR) pattern. Principal component analysis reduced a large number of psychological variables beforehand. Construct and outcome-based validity were explored using multivariate analysis of variance. Of the participants, 33.6% were categorized as DER, 29.4% as EER, 22% as FAR, and 15% as adaptive. Principal component analysis showed the factors activity-related pain behavior, affective distress, and dysfunctional pain thoughts. The AEFS-DK discriminated all 4 subgroups in terms or their pain behavior with EER>DER>AR>FAR. FAR showed less moderate/vigorous activity than DER and EER and more sedentary time than EER. DER and FAR showed higher affective distress, dysfunctional pain thoughts, and poorer outcomes than AR and EER. The results indicate good construct validity of the AEFS-DK discriminating the 4 avoidance-endurance model-related subgroups with respect to approach to activity behavior, psychological variables, and reported physical activity. Concerning outcome-based validity, 2 subgroups DER/FAR and AR/EER could be distinguished with inconclusive results for the eustress-endurance subgroup. Future studies are warranted using longitudinal research designs investigating whether AEFS subgroups differ in terms of treatment effects and long-term prognosis.

Therapeutic Effectiveness of AxioBionics Wearable Therapy Pain Management System in Patients with Chronic Lower Back Pain.

Chronic lower back pain is one of the most common medical conditions leading to a significant decrease in quality of life. This study retrospectively analyzed whether the AxioBionics Wearable Therapy Pain Management (WTPM) System, a customized and wearable electrical stimulation device, alleviated chronic lower back pain, and improved muscular function. This study assessed self-reported pain levels using the visual analog scale before and during the use of the AxioBionics WTPM System when performing normal activities such as sitting, standing, and walking (n = 69). Results showed that both at-rest and activity-related pain were significantly reduced during treatment with the AxioBionics WTPM System (% reduction in pain: 64% and 60%, respectively; P < .05). Thus, this study suggests that the AxioBionics WTPM System is efficacious in treating chronic lower back pain even when other therapies have failed to sufficiently decrease reported pain levels.

Using sensor-fusion and machine-learning algorithms to assess acute pain in non-verbal infants: a study protocol

IntroductionObjective pain assessment in non-verbal populations is clinically challenging due to their inability to express their pain via self-report. Repetitive exposures to acute or prolonged pain lead to clinical instability,...

Recent advances in tendinopathy.

Tendinopathy refers to the clinical diagnosis of activity-related pain resulting in a decline in tendon function. In the last few years, much has been published concerning the basic science and clinical investigation of tendinopathy and debates and discussions to new questions and points of view started many years ago. This advances review will discuss the current thinking on the basic science and clinical management of tendinopathy and in particular new findings in the tendon repair space that are relevant to the pathophysiology of tendinopathy. We will further discuss potential novel therapies on the horizon in human tendon disease.

Is There a Relationship Between Kinesiophobia and Physical Activity Level in Patients with Knee Osteoarthritis?

To investigate the levels of kinesiophobia, physical activity, depression, disability, and quality of life in patients with knee osteoarthritis. A cross-sectional study. A tertiary health care center. Ninety-six patients with knee osteoarthritis. Pain intensity was evaluated by the Visual Analog Scale, kinesiophobia by the Tampa Scale of Kinesiophobia and Brief Fear of Movement Scale, depression by the Beck Depression Inventory, disability by the Western Ontario and McMaster Universities Arthritis Index, physical activity level by the International Physical Activity Questionnaire short form, and quality of life by the Short Form 12 Health Survey Questionnaire. Of the patients, 85.7% had high-level kinesiophobia, 70.6% had depression, and 64.4% had low, 27.8% moderate, and 7.8% high physical activity levels. Age, activity-related pain score of the Visual Analog Scale, Tampa Scale of Kinesiophobia and Brief Fear of Movement Scale scores, and Western Ontario and McMaster Universities Arthritis Index and Beck Depression Inventory scores were higher in the group with high-level kinesiophobia, whereas the mental, physical, and total scores obtained from the Short Form 12 Health Survey Questionnaire were higher in the group with low-level kinesiophobia (P < 0.05). As the treatment of pain alone in patients with knee osteoarthritis is not sufficient to reduce fear of movement, we suggest that approaches to increase awareness of fear of movement and physical activity and cognitive behavioral therapy related to fear of movement should be included in the treatment program.

"I've been to physical therapy before, but not for the knees." A qualitative study exploring barriers and facilitators to physical therapy utilization for knee osteoarthritis.

Physical therapy (PT) is recommended to reduce pain and improve function. However, only 10%-15% of adults with knee osteoarthritis (OA) use PT in the United States. The purpose of this study was to explore patient-reported barriers and facilitators to PT utilization for knee OA, to understand why PT is underutilized. Qualitative descriptive study using semi-structured interviews was conducted, that is, one-on-one phone interviews with adults from local community centers. Participants were eligible if they were fluent in English and self-reported knee OA (1) over 45 years of age, (2) have activity-related knee pain, and (3) have no morning stiffness or morning stiffness in the knee(s) for ≤30 min. Interviews were audio-recorded and transcribed. To identify barriers and facilitators to PT utilization for knee OA, a coding framework, thematic analysis, and a constant comparative approach were used. Of 22 participants with health insurance and who participated, 59% were considering PT, 23% refused PT, and 18% used PT for knee OA. Themes identified as either barriers or facilitators for participants were (1) previous experience with PT, (2) physician referral, (3) beliefs about treatment efficacy before and after knee replacement surgery, (4) insurance coverage, and (5) preference to avoid surgery. A previous positive encounter with PT and a physician referral may facilitate PT utilization for adults with knee OA. Knowledge about and access to PT services were not identified as barriers related to PT utilization. Further research is necessary to confirm findings in a broader group of adults with knee OA.

1011 Sleep Duration Moderates the Association Between Next-Day Physical Activity and Pain Intensity Among Women with Fibromyalgia

Abstract Introduction Suboptimal sleep has been consistently associated with greater next-day pain intensity among women with fibromyalgia. In contrast, associations between physical activity and same-day pain in this population are contradictory. Given this inconsistency, we aimed to determine whether the daily physical activity-pain association is modified by sleep parameters. Methods This micro-longitudinal study used data collected using wrist-worn triaxial accelerometers over seven consecutive days by 44 adult women with fibromyalgia. Derived variables included sleep duration, sleep onset latency (SOL), wake after sleep onset (WASO), sleep efficiency (SE) and maximum daily physical activity count. Participants also completed digital diaries of refreshed sleep upon awakening (scale 0-100), and pain intensity (5x/day, scale 0-100). Multilevel linear regression models with interaction terms were used to investigate moderating effects of sleep on the next-day person-centered maximum physical activity-average pain intensity association. Results The sample mean age was 44 (SD 14). A total of 304 days of data were available for analysis. Mean sleep duration was 471min(SD 66); mean SOL 10min(SD 10); mean WASO 31min(SD 17), and mean SE 90%(SD 5). Sleep duration moderated the next-day maximum physical activity-pain association (Wald statistic p=0.01). After nights of both shorter (&amp;lt;7 hours) and longer sleep (&amp;gt;8 hours), higher levels of next-day maximum physical activity (compared to the participant’s overall study average) were associated with days of greater average pain. In contrast, after nights of 7-8 hours of sleep, higher levels of next-day maximum physical activity were associated with days of lower average pain. Conclusion An association between higher maximum physical activity and lower levels of pain was only observed after nights of 7-8 hours sleep. Engaging in physical activity is recommended for fibromyalgia-related pain management. Optimizing sleep duration may be useful in minimizing physical activity-related pain in this clinical population. Support DW is supported by a Foundation Fellowship Versus Arthritis. The study that provided data was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health (award number K01AR064275;PI:ALK). The Michigan Institute for Clinical &amp; Health Research provided subject recruitment support through the UMHealthResearch.org website (MICHR:NIH award number UL1TR002240).

Influencing factors of pain control among abdominal surgery patients with the enhanced recovery after surgery

Objective To explore the influencing factors of pain control among abdominal surgery patients with the enhanced recovery after surgery (ERAS) so as to provide a basis for improving pain control. Methods From May 2018 to November 2018, we selected 15 abdominal surgery patients with ERAS in Hepatobiliary and Pancreatic Surgery at Zhejiang Provincial People's Hospital by purposive sampling. Semi-structured interview was carried out with the method of phenomenology in qualitative research. Colaizzi 7-step analysis was used in data analysis to conclude themes. Results By interview data analysis, a total of 5 themes that had influences on pain control were concluded: activity-related pain and pain management after removing patient-controlled analgesia (PCA) ; adverse reaction related to pain management; recognition of patients and their family members on pain or pain treatment; information support for pain treatment; influence of non-medical service on patient satisfaction with pain control. Conclusions We should explore the operation mode of acute pain service organization suitable for our country. Muti-disciplinary team should be used for abdominal surgery patients to strengthen the management of activity-related pain and removing PCA, prevention and treatment for adverse reaction related to pain treatment, information support for pain treatment, and improve the recognition of patients and their family members on pain or pain treatment, and pay attention to the influence of non-medical service on patient satisfaction with pain control so as to improve pain control. Key words: Pain, postoperative; Pain management; Enhanced recovery after surgery; Abdominal surgery; Qualitative research; Phenomenology

Relation of pain mechanisms to development of knee pain in osteoarthritis in the multicenter osteoarthritis study

Purpose: The mechanism by which intermittent, activity-related or weight-bearing pain in knee osteoarthritis (OA) progresses to more persistent pain is not clear. Peripheral and central pain sensitization have been associated with pain severity, and abnormal descending pain modulation has been postulated to also be important in the pain experience, but as yet little is known about its role in those with knee OA. Whether any of these mechanisms impact the risk of developing knee pain, more pain severity, and/or change in pain patterns from intermittent to more persistent pain is not clear.

Femoroacetabular Impingement in the Adolescent Athlete

Femoroacetabular impingement syndrome (FAIS) is a source of hip pain that can present in adolescent athletes and is related to sports participation and extreme use in these patients. FAIS is characterized by morphologic abnormalities of the acetabulum and/or proximal femur that leads to pathologic contact within the hip joint. FAIS is classified as cam-type, pincer-type, or combined. Early sports participation is a factor in the development of symptomatic FAIS. Adolescent patients with FAIS are also more likely to have associated extra-articular pathologies. History and physical exam findings in adolescents with FAIS are not considerably different than corresponding findings in adults with FAIS and include activity-related groin pain aggravated by pivoting and flexion activities. FAIS can be treated conservatively or surgically. In refractory cases, outcomes after surgical intervention have been shown to be significantly better than nonsurgical treatment. Surgical intervention involves repairing damage to the labrum and/or cartilage and decompressing the bony impingement. Open and arthroscopic approaches have been shown to be safe and effective in adolescents with good outcomes. Most adolescent athletes are able to return to participation in their sport and a majority returning to their preinjury level of play after surgical intervention.

Vertical ground reaction forces during gait in children with and without calcaneal apophysitis

BackgroundHeightened vertical load beneath the foot has been anecdotally implicated in the development of activity-related heel pain of the calcaneal apophysis in children but is supported by limited evidence. Research questionThis study investigated whether vertical loading patterns during walking and running differed in children with and without calcaneal apophysitis. MethodsVertical ground reaction force, peak plantar pressure (forefoot, midfoot, heel) and temporospatial gait parameters (cadence, step length, stride, stance and swing phase durations) were determined in children with (n = 14) and without (n = 14) calcaneal apophysitis. Measures were acquired during barefoot walking and running at matched and self-selected speed using an instrumented treadmill, sampling at 120 Hz. Statistical comparisons between groups were made using repeated measure ANOVAs. ResultsThere were no significant between group differences in vertical ground reaction force peaks or regional peak plantar pressures. However, when normalised to stature, cadence was significantly higher (≈ 5%) and step length shorter (≈ 5%) in children with calcaneal apophysitis than those without, but only during running (P <.05). Maximum pressure beneath the rearfoot during running was significantly correlated with self-reported pain in children with calcaneal apophysitis. SignificancePeak vertical force and plantar pressures did not differ significantly in children with and without calcaneal apophysitis during walking or running. However, children with calcaneal apophysitis adopted a higher cadence than children without heel pain during running. While the findings suggest that children with calcaneal apophysitis may alter their cadence to lower pressure beneath the heel and, hence pain, they also highlight the benefit of evaluating running rather than walking gait in children with calcaneal apophysitis.

How Does Self-Efficacy Influence Pain Perception, Postural Stability and Range of Motion in Individuals with Chronic Low Back Pain?

Background: Low back pain (LBP) is the most prevalent musculoskeletal problem among adults. Individuals with chronic LBP (CLBP) can present a psychological disorder and a lack of pain self-efficacy. Objectives: The objective of this study was to compare the process of repetition-induced summation of activity-related pain, the lumbar range of motion, and the postural stability of patients with non-specific LBP (NSLBP) based on their level of self-efficacy. Study Design: This research used a descriptive, cross-sectional study design. Methods: This research included 60 patients with NSCLBP. Patients were classified as having “high” or “low” self-efficacy based on a median split of scores on the Chronic Pain Self-Efficacy Scale. All patients received a sociodemographic questionnaire, a psychological self-reported measures (Tampa scale of Kinesiophobia; Pain Catastrophizing Scale; Rumination subscale, Magnification subscale; Helplessness subscale; Roland-Morris Disability Questionnaire; FearAvoidance Belief Questionnaire; Physical Activity subscale; Work subscale); and completed the Temporal Summation Lifting Task, Lumbar Range of Motion, and Multi-Directional Functional Reach Test (MDFRT). Results: The results indicated that the low self-efficacy group had a shorter lumbar range of motion and lower postural stability, in addition to greater pain intensity in the temporal summation lifting task, compared with the high self-efficacy group. The analysis showed that the strongest correlation for the high self-efficacy was between fear of movement and the temporal summation lifting task, and greater scores at the psychological questionnaires, compared with the high selfefficacy group (r = 0.711; P &lt; 0.01). The strongest correlations found for the low self-efficacy group, showed a positive relationship between pain catastrophizing and the temporal summation lifting task (r = 0.765; P &lt; 0.01), and a strong negative association between pain catastrophizing for the magnification subscale and lumbar range of motion (r = -0.759; P &lt; 0.01). Limitations: The results of this study should be interpreted with caution because of its crosssectional design, and therefore causal relationships cannot be established. A significant limitation of the study is that patients’ physical activity levels were not assessed, which could have influenced their ability to perform motor tasks at the perceived difficulty and fear level. Conclusions: The high self-efficacy group had less pain in the temporal summation lifting task, a greater range of motion, and a greater functional range, in addition to a lower influence of psychological factors. Key words: Low back pain, chronic pain, self-efficacy, temporal summation, range of motion, postural stability, fear of movement, pain catastrophizing, low back disability

In Brief: The Lichtman Classification for Kienböck Disease.

In Brief: The Lichtman Classification for Kienböck Disease.

Characterization of a Novel Calcific Achilles Tendinopathy Model in Mice: Contralateral Tendinopathy Induced by Unilateral Tenotomy.

Achilles tendinopathy is a significant clinical disease characterized by activity-related pain, focal movement limitation, and intratendinous imaging changes. However, treatment of Achilles tendinopathy has been based mainly on theoretical rationale and clinical experience because of its unclear underlying pathogenesis and mechanism. The purpose of the study was to develop a simple but reproducible overuse-induced animal model of Achilles tendinopathy in mice to better understand the underlying mechanism and prevent calcific Achilles tendinopathy. A total of 80 C57/B6 mice (8 or 9weeks old) were employed and randomly divided into control and experimental groups. Unilateral Achilles tenotomy was performed on the right hind limbs in the experiment group. 12 weeks after unilateral Achilles tenotomy, the onset of Achilles tendinopathy in the contralateral Achilles tendon was determined by radiological assessment, histologic analysis, electron microscopy observation, and biomechanical test. The onset of calcific Achilles tendinopathy in contralateral Achilles tendon was confirmed after 12 weeks of unilateral tenotomy. The contralateral Achilles tendon in the experimental group was characterized as hypercellularity, neovascularization, and fused collagen fiber disarrangement, compared with the control group. Importantly, intra-tendon endochondral ossification and calcaneus deformity were featured in contralateral Achilles tendon. In addition, poor biomechanical properties in the contralateral Achilles tendon revealed the incidence of Achilles tendinopathy. We hereby introduce a novel, simple, but reproducible spontaneous contralateral calcific Achilles tendinopathy model in mice, which represents overuse conditions during tendinopathy development in humans. It should be a useful tool to further study the underlying pathogenesis of calcific Achilles tendinopathy.

Acupuncture from Tiaokou (ST 38) to Chengshan (BL 57) combined with local exercise for periarthritis

To compare the effect difference between acupuncture from Tiaokou (ST 38) to Chengshan (BL 57) combined with local exercise and acupuncture. Sixty patients with periarthritis were randomly divided into an acupuncture group and an acupuncture combined with exercise group (active acupuncture group), 30 cases in each group. Acupuncture from Tiaokou (ST 38) to Chengshan (BL 57) was given in both groups. The active shoulder joint during acupuncture was applied in the active acupuncture group. The treatment was given once every two days, 5 times as one course and a total of 2 courses were required. The activity-related pain (VAS score), shoulder joint activity (Melle score), and daily living ability (ADL score) were observed before and after treatment in the two groups. The VAS score, Melle score and ADL score were significantly lower in the two groups after treatment compared with those before treatment (all P<0.05); the VAS score, Melle score, and ADL score in the active acupuncture group were lower than those in the acupuncture group (all P<0.05). The curative effect of acupuncture from Tiaokou (ST 38) to Chengshan (BL 57) combined with local exercise on periarthritis is superior to that of acupuncture from Tiaokou (ST 38) to Chengshan (BL 57) alone.

Differences in Athletic Performance Between Sportsmen With Symptomatic Femoroacetabular Impingement and Healthy Controls.

Femoroacetabular impingement (FAI) is a commonly recognized condition in athletes characterized by activity-related hip pain and stiffness, which if left untreated can progress to hip osteoarthritis. The aim of the study was to determine the effect of symptomatic FAI on performance in young athletes based on the hypothesis that athletes with FAI would show deficits in performance compared with healthy controls. The functional performance of a cohort of preoperative, competitive sportsmen with symptomatic FAI (FAI group, n = 54), was compared with that of a group of age, sex and activity-level matched controls (n = 66). Participants performed functional tests including a 10-m sprint, a modified agility T-test, a maximal deep squat test and a single-leg drop jump (reactive strength index). Hip range of motion was assessed by measuring maximal hip flexion, abduction, and internal rotation (at 90 degree hip flexion). The FAI group was significantly slower during the 10-m sprint (3%, P = 0.002) and agility T-test (8%, P < 0.001); flexion, abduction, and internal rotation values for the FAI group were reduced compared with controls (P < 0.001). No significant differences between groups were identified for squat depth or reactive strength index. The FAI group also reported higher levels of anterior groin pain during the 10-m sprint, modified agility T-test, and while squatting. Many sportsmen with confirmed FAI continue sports participation up to and after diagnosis, despite issues with activity-related pain and stiffness. This study highlights the functional limitations in speed, agility, and flexibility that are likely to be present in this group of FAI patients.

Fixation of the Fractured Lunate in Kienböck Disease.

To describe an uncommon subset of fractured lunates in Kienböck disease that is salvageable by internal fixation. We performed a retrospective review for patients with Kienböck disease treated by internal fixation. Demographic data, objective and radiographic measurements, patient-reported outcome measures (Disabilities of the Arm, Shoulder, and Hand and Patient-Rated Wrist Evaluation) and pain (visual analog scale) scores were collected. Of the 7 patients treated, 5 were available for review. At an average follow-up of 7.1 years (range, 1.5-15 years), all patients had activity-related wrist pain but were pain-free at rest. Radiographic assessment showed union in all lunates and a normal radioscaphoid angle and Stahl index. The modified carpal height ratio was reduced in 4 patients and normal in one. There was no observed narrowing or irregularity of the radiocarpal or midcarpal joints. Patient-reported outcome measures in 2 patients were unsatisfactory. Computed tomography of the lunate in Kienböck disease is an important investigative tool. A coronal split fracture of these lunates can be salvageable by internal fixation. Revascularization of the lunate can be performed when the fragment is of sufficient size. Therapeutic V.