Morbus Preiser - Causes, Symptoms and Therapy

Scaphoid necrosis, Preiser's disease

Morbus Preiser is a so-called aseptic bone necrosis on the wrist, especially of the scaphoid bone. Wrist pain and related mobility impairments are consequences of the condition.

contents

• Scaphoid necrosis, Preiser's disease
• definition
• Occurrence and causes
• Symptoms and complaints in Morbus Preiser

definition

A necrosis of the scaphoid bone (scaphoid), which has no influence of pathogens or without infection, is referred to their discoverer as Preiser's disease or Preiser's disease (first description of the disease in 1910). Alternatively, the term "scaphoid necrosis" can also be used for aseptic bone necrosis on the scaphoid bone.

Necrosis can theoretically occur on all hand and finger bones. A special form is aseptic scaphoid necrosis, also known as Preiser's disease. (Photo: elviragerecht / fotolia.com)

Occurrence and causes

As with all bone necrosis, there is also an infarct of the bone with corresponding deficiency in the bone tissue in this disease. Affected is the scaphoid bone (Os Scaphoideum) on the wrist. In the second largest carpal bones occur in Morbus Preiser from previously unexplained reason disorders of the blood circulation, resulting in a corresponding undersupply of minerals and oxygen. The bone substance is thereby increasingly weakened and it sets in an osteonecrosis.

As a cause of circulatory disorder, microtraumatization and traumatic influences such as fractures (bone fractures) are discussed. However, a clear, medically reliable statement on the causes of the disease can not be made so far in most cases. Exceptions here are scaphoid necroses, which are directly related to a vascular disease such as collagenosis or occur in the context of progressive systemic sclerosis.

Various general risk factors of bone necrosis, such as the systemic use of cortisone or a disease of diabetes, are also discussed in the context of Preiser's disease.

Symptoms and complaints in Morbus Preiser

The discomfort of scaphoid necrosis depends on which and how many parts of the bone are not being properly treated. Here it is decisive for the symptomatology, which portion of the navicular bone was cut off from the blood circulation or infested by the bone infarct. Small bone infarcts can
also asymptomatic.

Wrist pain that can radiate to the forearm is a typical result of Preiser's disease. (Image: Adiano / fotolia.com)

Usually, in a scaphoid necrosis wrist pain, which occur sometimes abruptly, but also be intermittent and can increase. Most of the pain occurs under load and radiate in the direction of the so-called foveola radialis (dimples between the thumb and wrist, also called anatomical Tabatière) and in the direction of the forearm, so that accompanying lower arm pain can occur. The hand may also appear overheated and swollen in the area of ​​the navicular bone. Pain also appears on pressure on the scaphoid bone.

Due to the necrosis of the scaphoid bone, severely severe forms of movement and strain restrictions on the severely threatened forms of the hand, which are associated with significant restrictions in everyday life. If necessary, professional activities with the hands can no longer be carried out.

Even if the suspicion of a scaphoid necrosis can often already be established on the basis of the described symptoms, it is necessary to confirm the diagnosis of some examinations by means of imaging techniques (X-ray, CT, MRI). The loss of bone substance is usually obvious and statements about the severity of the disease can be made. Last but not least, the imaging techniques are used to rule out other diseases, such as a scaphoid fracture or a bone tumor.

In most cases, the treatment of Morbus Preiser is planned to be immobilized with a plaster cast. (Image: Fenton / fotolia.com)

therapy

The treatment of Preiser's disease depends directly on the extent of bone infarction and can range from immobilization using plaster cast and physiotherapy, to local or systemic medication, to surgery. For example, surgery is required when the navicular bone is altered in shape by the massive necrosis. Also, the bone can be selectively drilled at an early stage of the disease to re-stimulate blood circulation and to allow regeneration of the bone substance. In severe forms of illness, there is also the possibility of so-called arthrodesis (operative joint stiffening) in order to at least partially restore function and resilience. (Tf, fp)
Specialist supervision: Barbara Schindewolf-Lensch (doctor)