If I have Kienbocks disease diagnosed on MRI but not plain xray, and have pain, what are my options?

Firstly, a trial of immobilization for 6-8 weeks may help. If there is synovitis in the wrist, a cortisone injection may help. If conservative options do not help, however, an operation for this early stage which "unloads" the lunate is the best option. Although a radial shortening is the most typical surgery---if the ulna bone is not short, this option may result in ulnar wrist pain. In these types of situations, a closing wedge type of radial osteotomy may be a better option; aternatively, capitate shortening with a fusion between the Capitate and Hamate bones can be performed.

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