Kienbock’s disease is a chronic and progressive condition that, if untreated, will continue to cause patients increasing pain, joint stiffness, and limited movement, with severe cases resulting in arthritis in the wrist.
However, this condition is manageable, and Kienbock’s disease treatment focuses on relieving pain while maintaining, and in some cases improving wrist function.
In this post, we highlight Kienbock disease prognosis, how the disease can progress if left untreated, treatment options, and prognosis without surgery.
Kienbock long-term outlook
Kienbock disease progression is a condition that can go undiagnosed for many years, often feeling like a sprained wrist or pain coming and going intermittently.
Progressing slowly over many years, Kienbock’s disease is caused when the blood supply to the lunate bone is limited or cut off completely, causing the bone to deteriorate and die.
Adults are more at risk of developing this condition; however, Kienbock’s disease can happen at any age to anyone.
(Note: Those who have sickle cell anaemia, lupus, or cerebral palsy may be at higher risk than others.)
Prognosis of the condition is variable and will depend on the stage and severity, with diagnosis of the disease and stage determined through X-rays, MRI’s, CT scans, and even bone scans for more detailed views.
Stages of Kienbock’s disease
Stage 1 – pain felt in the wrist, feels like a sprain, may be tender to touch, and sore when moving/carrying out everyday activities.
Stage 2 – blood supply to the lunate is limited, causing the bone to begin to harden. Grip strength is beginning to weaken, and wrist function is starting to deteriorate.
Stage 3 – the lunate is now breaking down; there is limited movement in the wrist, and pain is increasing.
Stage 4 – blood supply is completely cut off, and the lunate has broken down entirely. Wrist function is extremely limited, the wrist can be swollen, and incredibly tender.
Will Kienbock get worse?
Without the right treatment, and prompt treatment with early diagnosis, Kienbock’s disease will continue to get worse, with patients moving through the stages gradually.
Grip strength and range of motion will decrease, leading to arthritis and preventing you from carrying out everyday activities.
Can Kienbock be cured?
For all, there is no exact cure for Kienbock’s disease; with the right treatment, wrist function can be preserved and, most importantly, pain relieved.
Kienbock treatment options can include both non-surgical and surgical. Kienbock surgery options can include:
Joint levelling
If, after scans and x-rays, it is found that you have varying length bones, the ulna and the radius, surgery will be required to remove a small piece of bone to shorten them to the required length, or bone grafts will be carried out to lengthen them. Bone levelling reduces compression on the lunate and halts the progression of the disease.
Revascularisation
This surgical procedure helps to restore blood flow to the lunate by taking a small piece of bone from another part of your body (typically the forearm) and placing it in the lunate along with the feeder blood vessels. Pins are then used to keep the bone in place as it heals, and a metal structure is secured outside the wrist to stabilise and immobilise the wrist while it heals. This procedure is more successful when the patient is at stages 1 or 2 of the condition.
Fusion
Fusion surgery can be either partial or complete and includes fusing together some or all of the bones in the wrist. (Note: A complete fusion removes mobility in the wrist but keeps movement in the forearm and is required if the patient has been diagnosed with severe arthritis.
Proximal row carpectomy
If the lunate has severely collapsed, the bone can be completely removed, with two bones on either side of the lunate also being removed. This surgical option will relieve pain while maintaining partial wrist motion.
Lunate excision (arthroplasty)
Full removal of the lunate bone, with the option to add an artificial bone and prosthetics to replace and restore function and mobility.
After any surgical procedure, patients will be required to wear a wrist support for 3 to 4 months, attend follow-up appointments to ensure the wrist is healing as it should be, and then undergo physical therapy to help regain strength and movement.
Kienbock prognosis without surgery
It’s important to get the right Kienbock treatment for your stage of the condition as soon as possible, as without treatment, the condition will continue to progress.
At Ladan Hajipour, we tailor treatment options to you. We take a full medical history and carefully examine the hand and wrist, taking into account your activity levels, symptom tolerance, joint arthritis, and the severity of the lunate collapse.
There is no immediate cure or quick fix for Kienbock’s disease, but there is a range of options available to help stop or indeed slow down the progression of the disease.
Let our team help you today.
If you are experiencing any pain or discomfort in your wrist or hand, speak to one of our professional team members today.