Kienböck’s disease is a rare, debilitating condition that can lead to chronic pain and dysfunction. It happens when one of the eight small carpal bones in the wrist – the lunate bone, more specifically – becomes damaged because there is no blood supply.
It is also known as avascular necrosis of the lunate, or osteonecrosis of the lunate.
Symptoms
You may wonder if you suffer from Kienböck’s Disease if you experience the following:
- Swelling, pain, and stiffness in the wrist
- Clicking, or clunking in the wrist
- Weakening of grip strength
- Tenderness directly over the lunate bone
- Difficulty, or pain when turning the hand upward
If you think the above symptoms apply to you, make an appointment with your surgeon to get an accurate diagnosis. There are other wrist conditions which may present the same range of symptoms, as well.
Treatments
There are four stages of progression of Kienböck’s disease. The treatment differs, depending on the stage of the condition at the time of commencing it.
Some patients may undergo several different procedures during their lifetime.
Untreated, a person with Kienböck’s disease will see a progressive deterioration of the wrist, loss of wrist function and increasing pain. That’s why it’s very important to see a doctor as soon as possible, after experiencing the first unsettling symptoms described above.
Stage I
Kienböck’s disease may be difficult to diagnose accurately in the early stages. This is because the signs and symptoms resemble those of many other conditions, such as wrist sprains, or even arthritis.
At this stage there are no visible changes on an x-ray, they can be seen only on MRI imaging. The common treatment is immobilization and non-steroid anti-inflammatories (NSAIDS).
In the later stages, an x-ray will reveal the damage, and a CT scan may be able to determine the number and size of the bone fragments.
Stage II
As the disease progresses, the next symptom will be sclerosis of the lunate bone. At this stage, the treatment will be decided by an experienced surgeon, and may include:
- Joint leveling procedure
- Radial wedge osteotomy
- STT fusion
- Distal radius core decompression
- Revascularization procedure
Stage IIIA
At this next stage, a lunate collapse and no scaphoid rotation may be new symptoms that appear. The possible treatments are the same as at stage II.
Stage IIIB
Instead of stage IIIA, you may experience stage IIIB, depending on the scaphoid rotation symptom. At stage IIIB, your symptoms include a lunate collapse with fixed scaphoid rotation. Because of this difference, the treatment proposed could differ too, and be decided by an experienced surgeon between:
- proximal row carpectomy,
- STT fusion, or
- SC fusion.
Stage IV
This is the most advanced stage of Kienböck’s disease. The adjacent intercarpal joints become degenerated, and the treatment options are complicated, as well. Your orthopedic surgeon will probably suggest one of the following, as the best option to ensure your recovery:
- wrist fusion
- proximal row carpectomy, or
- limited intercarpal fusion
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The material contained on this site is for informational purposes only and DOES NOT CONSTITUTE THE PROVIDING OF MEDICAL ADVICE, and is not intended to be a substitute for independent professional medical judgment, advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare providers with any questions or concerns you may have regarding your health.
