Bilateral Avascular Necrosis of the Lunate in a Patient with Severe Raynaud's Phenomenon and Scleroderma.

We report a case of bilateral avascular necrosis of the lunate, Kienböck's disease, occurring in a patient with limited scleroderma and severe Raynaud's phenomenon who had never received corticosteroids. The patient also had bilateral congenital shortening of the ulnar, which can predispose to Kienböck's disease. The avascular necrosis of the lunate occurred during exacerbations of the Raynaud's phenomenon, which suggests that it was precipitated by the vascular changes associated with Raynaud's phenomenon in scleroderma. Avascular necrosis of the carpus should be considered in the differential diagnosis of patients with chronic wrist pain and scleroderma.