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Kienbock’s disease

Overview

Kienbock’s disease occurs when blood flow to one of the bones near the wrist, the lunate bone, is cut off. This can eventually cause the bone to die, leading to a variety of symptoms including difficulty turning the hand. To alleviate Kienbock’s disease, medical providers seek to relieve pressure on the bone and restore proper blood flow.

  • Symptoms

    • Decreased grip strength
    • Difficulty turning the hand upward
    • Limited range of motion in the wrist
    • Pain and swelling in the wrist
    • Tenderness over the lunate bone in the middle of the wrist
    • Weakness in the hand
  • Prevention

    • Because wrist trauma can be associated with Kienbock’s disease, avoid activities that place undue pressure on the wrist.
  • Risk factors

    • Having an ulna and radius in the forearm that are different lengths
    • Having had wrist trauma
    • Having only one blood vessel supplying blood to the lunate, rather than the normal two
  • Diagnosis

    • Medical history and symptom review. During your medical appointment, your provider will carefully review your symptoms and take a complete medical history. This will likely include discussion of your activities, including anything that could have placed pressure on your wrist.
    • Physical examination. Following a review of your symptoms, your medical provider will then complete a physical examination of your hand and wrist. This will include movement of your wrist to assess any limitations you exhibit, such as limited range of motion or inability to turn the hand upward.
    • Imaging tests. Since symptoms related to Kienbock’s disease often mirror those of a sprained wrist, your provider will likely order X-rays or MRI scans to confirm a diagnosis of Kienbock’s disease. These imaging scans will also help determine the severity of the condition, which ranges from stage 1 to stage 4.
  • Treatment

    Early stages

    • Your symptoms may be managed using anti-inflammatory medications since early stages of the disease do not constrict blood flow.
    • Your medical provider will also likely recommend immobilizing the wrist to relieve pressure on the lunate bone. This may include casting or splinting for up to several weeks.
    • Your provider will also recommend modifying your activities to avoid placing pressure on the wrist.

    Later stages

    In the later stages of Kienbock’s disease, the following surgical treatment may be required:

    • Revascularization is a procedure in which part of a different bone and its attached blood vessels are removed and inserted into the lunate bone. This graft helps restore blood supply to the lunate.
    • Joint leveling is a procedure recommended when the ulna and radius in the forearm are of different lengths. During this procedure, a bone is made longer or shorter to even those two bones out, removing compression on the lunate.
    • Proximal row carpectomy is called for in extreme cases where the lunate is collapsed or broken into pieces. This involves removing the lunate and two bones on either side of it, relieving pain while maintaining some wrist motion.
    • Fusion, which involves fusing together nearby wrist bones into one bone, is also an option in severe cases.
  • Follow-up care

    • After surgery, carefully follow any directions from your medical provider, including instructions on prohibited activities and rest.
    • If pain and other symptoms continue, further treatment may be necessary, so seek medical attention.