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Stage 1:
- Symptoms are similar to those of a wrist sprain. X-rays may be normal or show a line indicating a possible fracture. Linear or compression fractures are not uncommon in stage 1, but can be difficult to see on x-ray. Magnetic resonance imaging (MRI) may be helpful in making the diagnosis in this early stage. The shape of the lunate bone appears normal.
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Stage 2:
- The lunate bone begins to harden. The part of the lunate bone next to the radius (forearm bone) may look flat instead of a rounded appearance. On an X-ray, it may appear brighter or whiter than the surrounding bones. These changes indicate that the bone is dying. Either an MRI or a computed tomography (CT) scan may be used to assess the condition of the bone. Recurrent pain, swelling, and wrist tenderness are common.
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Stage 3:
- The dead bone begins to collapse (the part of the lunate bone next to the radius is “crushed” into itself) and break into pieces. The surrounding bones may begin to shift position. Patients experience increasing pain, weakness in gripping, and limited motion. This stage is divided into A and B, progression into 3B is specifically marked by fixed rotation of the scaphoid bone (located immediately next to the lunate, on the thumb side).
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Stage 4:
- The surfaces of the adjoining bones are affected, resulting in arthritis of the wrist.
Contributed by Phyllis Walker
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