Overview

What is Kienbock's disease?

Kienbock's disease is a relatively uncommon condition that interferes with blood flow to the lunate. The lunate is one of eight small bones in your wrist. It's your middle bone at the bottom of your wrist and is important for many motions at your wrist.

Early-stage Kienbock'scauses pain. As the disease progresses, it can cause death of bone tissue and pain, loss of motion, and arthritis in the wrist.

Kienbock's disease typically affects one wrist. Surgery and other treatments are used to reduce pain and preserve wrist function.

How can you get Kienbock's disease?

Though the true cause of Kienbock's disease is unknown, some reasons why your lunate bone might collapse include:

Less blood to your lunate: Scientists think this is the most likely cause. When your bone is deprived of nourishing blood, it can die, a condition called osteonecrosis.
Trauma to your lunate: Maybe a minor injury caused by a car accident, among others.
Your forearm bones are not square: In that regard, because they vary in length, for example, when the ulna and radius bones of your forearm are of different lengths, this can cause problems in your wrist.
An abnormal shape of the lunate: You may even have been born with the wrong shape.

What are the signs and symptoms of Kienbock's disease?

Early in the disease process, your wrist hurts. As the disease progresses, symptoms include:

Tenderness over the bone
Stiffness
Swelling
Decreased hand grip
Reluctance of the hand to turn upward
Clicking sensation when your wrist moves

How is Kienbock's disease diagnosed?

You will be evaluated by your doctor and will be asked to detail the symptoms you are having. Try to be as specific as possible about where and what the pain feels like and how long you have had pain. Your doctor might order some tests, such as:

X-ray.
MRI.
CT scan.
Bone scan.

What are the stages of Kienbock's disease?

Your doctor may inform you about the stage of Kienbock's disease. Stage 1 is the mildest, and stage 4 is the most severe. MRI and CT scans help evaluate the stage as well by first ruling out fractures and detecting blood flow.

Stage 1: In the first stage, you will likely experience discomfort as if your wrist was sprained. You won't know what is happening to your body at this point, but there's a high chance that blood flow to your lunate is slowing down or has even stopped.
Stage 2: In the second stage, your lunate becomes sclerotic due to the absence of blood flow. The process of becoming sclerotic results in your bone dying.
Stage 3: Within the third stage, your calcified lunate will tend to crack. This may make other bones in your wrist move around. You may feel an increased amount of pain, you may find it difficult to grip things with as much strength, and you may only be able to move around.
Stage 4: Within the fourth stage, the sides of the bones close to your lunate will also become weakened. Your wrist may become arthritic.

It could be several months or even several years between stages 1 and stage 4.

What are the treatment options for patients?

The treatment of Kienbock's disease varies according to the degree of pain and the stage of the deterioration of the lunate.

During the early stages of Kienbock's disease, your doctor may prescribe anti-inflammatory medications to help alleviate the pain and swelling. Immobilizing the wrist would take pressure off the lunate bone and help restore blood flow. Your doctor might advise you to wear your wrist in a splint or cast for 2 or 3 weeks so that it remains immobile.

Another benefit of physical therapy is an improvement in wrist range of motion. A physical therapist can schedule follow-up check-ups and provide an exercise schedule to help you continue using your wrist.

In cases where the pain worsens or if the lunate has deteriorated, your doctor may have to perform surgery. This depends on the extent of damage and includes several options.

Revascularization: This is bone and blood vessel grafting from another part of the bone in your hand or arm to lunate to reinstate blood supply. A metal piece attached to your wrist can serve as an external fixator to hold the graft in place as well as reduce the pressure around the lunate.
Capitate-shortening osteotomy: They differ in their progression, from the mildest, stage 1, to the most severe, stage 4. They are utilized during the early stages of Kienbock's disease, combined with revascularization.
Joint leveling: If your two forearm bones are unequal, this procedure prevents the progression of the disease.Your doctor may ask you to wear your wrist in a splint or a cast for 2 to 3 weeks, keeping it immobile. This helps relieve pressure from the lunate.
Metaphyseal core decompression: This operation removes a part of another wrist bone, called the capitate, and attaches it to several other parts of the same bone.
Proximal row carpectomy: This is a procedure that removes the lunate bone if it has collapsed, along with two adjoining bones. This eliminates pain but leaves you with partial motion in your wrist.
Fusion: The lunate is fused to adjoining bones, creating a solid bone. This procedure eliminates pain and leaves you with partial motion in your wrist.
Arthroplasty: It would require a proximal, in-line, total wrist joint replacement. One type of resection arthroplasty has been reported in which the lunate is removed and replaced by an artificial bone made of silicon or pyrocarbon; however, it is used much less frequently.

What can I do to prevent or lessen my risk of Kienbock's disease?

There is nothing you can do to definitely prevent Kienbock's disease, but there are effective treatments.

Your risk of developing Kienbock's disease is lower if you have two arteries supplying the blood to your lunate when you are born, compared with having only one.

What is the prognosis for patients with Kienbock's disease?

Sometimes, Kienbock's disease may lead to arthritis on the wrist. This unfortunately is a complication of the disease. Discuss this risk factor with your health provider and come up with a plan for how to deal with it.

When should I contact my healthcare provider?

Do not wait until the symptoms above become worse before you visit your healthcare provider. This procedure levels your forearm bones by scraping the two bones involved without removing any bone tissue. Contact your healthcare provider if you: