Preiser disease refers to idiopathic avascular necrosis of the scaphoid bone.

Causes / typical injury mechanism: Preiser disease is a rare condition with an unclear etiology. Possible causes for Preiser disease include:

• Trauma or microtrauma
• Tobacco use
• Corticosteroid use
• Chemotherapy
• Systemic diseases (eg, autoimmune hemolytic anemia, systemic lupus erythematosus, and post renal transplantation)
• Thumb hypoplasia

Classic history and presentation: Preiser disease commonly manifests as chronic, radial-sided wrist pain. There is usually no identifiable trauma that precipitates this pain. Range of motion is typically limited, and grip strength is often reduced.

Prevalence:

• Age – Preiser disease affects people of all ages but is typically diagnosed in middle-aged adults.
• Sex / gender – Some evidence suggests that women are affected more than men.

Risk factors: Smoking, alcohol use disorder, infection, and a history of trauma to the region are all risk factors for Preiser disease.

Pathophysiology: The scaphoid has a retrograde blood supply and a poorly vascularized proximal pole. The limited vascularity of the scaphoid causes it to be particularly sensitive to occlusion, which can thus lead to avascular necrosis.

Grade / classification system:
Several classification systems exist.

Herbert-Lanzetta classification
This classification system grades Preiser disease based on the appearance of the scaphoid on plain radiographs. The stages are as follows:

• Stage 1 – The plain radiograph is normal, but increased uptake is observed on bone scan.
• Stage 2 – Increased density of the scaphoid's proximal pole.
• Stage 3 – Fragmentation of the proximal pole of the scaphoid with or without pathologic fracture.
• Stage 4 – Osteoarthritis and carpal collapse.

Kalainov classification
This classification system grades Preiser disease based on the scaphoid's appearance on MRI.

• Type 1 – Involvement of the entire scaphoid.
• Type 2 – Involvement of the proximal pole of the scaphoid.

Type 1 carries a worse prognosis than type 2.