Kienbock disease refers to the condition also known as avascular necrosis of the lunate carpal bone.
Ultimately, there is a lack or loss of blood supply to one of the prominent carpal bones, the lunate, resulting in the bone slowly dying and causing significant problems with the wrist.
This lunate bone condition often starts slowly and will possibly go unnoticed for months until symptoms become more aggressive and severe.
It’s important that if you do experience any symptoms or have any trauma to the wrist and hand, you seek professional advice as soon as possible.
Wrist bone disease
Kienbock’s is a rare bone disorder affecting the lunate, where ultimately the bone itself has stopped receiving the necessary amount of blood, leading to death of the bone. This particular condition is most common in men aged 20 to 40, but it can occur at any age.
Kienbock’s wrist occurs when there is a breakdown of the lunate bone that sits within the
proximal row of the wrist.
This breakdown can be caused by:
- Less blood flow reaching the lunate
- Trauma to the wrist and hand (typically experienced after a fall in which the wrist has been left outstretched)
- Irregular-sized forearm bones
- Irregular lunate shape.
Lunate bone disease starts slowly, but without the right treatment, it will continue to get worse and progress, leading to the bone eventually dying and arthritis appearing in the wrist.
Kienbock’s wrist can affect anyone at any age; however, we find that it is more prevalent in adults and those with pre-existing medical conditions such as lupus, sickle cell, and cerebral palsy.
Kienbock’s disease diagnosis
Diagnosis of Kienbock’s will come in the form of a detailed medical history as well as an exploration of the patient’s current symptoms.
Such symptoms that a patient may experience include:
- Limited wrist movement
- Swelling
- Pain/tender to touch
- Weakness when carrying out normal activities.
Diagnosis will also include:
- X-rays
- CT scans to check bones
- MRI scans to check blood flow
Stages of lunate wrist disease
Stage 1 – pain and the condition at this stage are considered minor, as there is a small loss of blood supply, making bones weak. However, pain will be minimal, so it may go unnoticed, feeling more like a wrist sprain. At this stage, an X-ray may not be able to pick up anything, so an MRI would be more effective for a better understanding of blood flow.
Stage 2 – at this stage, the lunate bone itself will become hard, and the wrist will be sore to touch and move. X-rays will show a bright white lunate bone, which will highlight to the wrist specialist that the bone is slowly dying. Pain and swelling will be apparent at this stage.
Stage 3 – It is at this stage that the bone will begin to break down and affect other bones within the wrist. This can often cause the bones to shift in position, leading to growing pain, a weak grip, and limited wrist movement.
Stage 4 – The lunate bone at this stage will collapse completely. This results in the need for surgery to remedy the damage to the bone and ligaments.
Kienbock treatment
There are both surgical and non-surgical treatments available, and you should discuss all of the appropriate treatment options available to you when choosing which is the best course of action for you to take.
Treatment can include:
- Over-the-counter medications, such as anti-inflammatories and pain relievers, can help reduce swelling and manage pain symptoms.
- Immobilisation of the wrist – including a splint to stabilise and rest the wrist.
- Physiotherapy – providing the patient with a range of exercises to help strengthen the wrist and regain full function.
- Surgery, which can include:
- Revascularisation – this surgical procedure involves inserting a vascularised graft into the lunate bone.
- Joint levelling – a more intricate surgery that involves lengthening or shortening the forearm (radius and ulna) bones.
- Fusion – here, the wrist joint is stabilised by fusing the forearm bone, radius, with the other small carpal bones, immobilizing the wrist.
Wrist specialists here to help
At Ladan Hajipour, we work closely with all of our patients to ensure the right treatment plan for you.
We want to provide you with all the relevant and appropriate information that is right for your circumstances so that you can make the most informed decision about your treatment.
Our aim?
To help you regain full motion and function of your wrist, pain-free. Allowing you to get back to everyday activities and activities you enjoy.
If you are experiencing pain, swelling, tenderness, reduced grip strength, or limited motion in your wrist, don’t leave it; speak to a member of our team today and let us assess your wrist and hand in depth.
Book your consultation with us today.
Call 0808 1010 337 or email us your questions, and we’d be happy to help.