Often mistaken for a wrist sprain because the similar symptoms including, swelling, pain and tenderness, stiffness, difficulty gripping and turning the hand.

INJURY
Kienböck’s Disease

ALSO KNOWN AS
Osteonecrosis, Avascular Necrosis of the Lunate

ABOUT
Kienböck’s Disease occurs when there is a lack of blood supply to the lunate bone, one of the small bones in the wrist. Bones require a healthy blood supply for sustenance and if this is interrupted the bone can eventually die.

COMMON INJURY
The exact cause is not known but it is possible for an injury to the the wrist to disrupt the blood flow to the lunate bone. This disease can also be caused due to slower flow to the bone if you only have only one blood vessel supplying to the lunate instead of two or due to increased pressure from one of the two bones in the forearm.

DIAGNOSIS

It is often mistaken for a wrist sprain because the similar symptoms including, swelling, pain and tenderness, stiffness, difficulty gripping and turning the hand. There are four degrees of progression:

  1. Early stages are when the symptoms feel like a sprained wrist and the help of an MRI can diagnose early by showing blood flow.
  2. The sclerosis period is where the lack of blood causes the affected lunate bone to harden and die.
  3. The bone breaks into pieces and the neighboring bones may shift in response.
  4. The neighboring bones to the lunate can also begin to decline and become arthritic.

Early diagnosis may be difficult because the symptoms mimic a wrist sprain. Your physician will discuss our symptoms and do a physical exam but x-rays and/or MRI will help to confirm Kienböck’s disease. In the later stages where the bone has hardened it looks whiter on x-rays and easier to diagnose. MRI’s and CT scans may be ordered to tell a better story for your physician.


NON SURGICAL TREATMENT
The objective is to relieve pressure and restore blood flow to the bone but there is no cure. Immobilizing your wrist in the very early stages can help decrease pressure and anti-inflammatory medications can help with pain and swelling.

SURGICAL TREATMENT

Depending on progression there are several surgical options for treatment.

Revascularization is possible in the early stages before the bone greatly declines. This surgery uses a vascular graft, which takes a piece of another bone that has a working blood vessel attached and is inserted into the diseases lunate bone to restore a supply of blood. Following this surgery an external fixator may be used to relieve pressure on the lunate bone while it is healing.

Joint leveling is used when Kienböck’s disease is originated from the pressure from one of the two bones in the forearm (radius or ulna) not being the same length. Bones can be made longer and thus leveled, by using bone grafts. Or a bone can be shortened by removing a section of the bone to level the bones and reduce the pressure and stop progression of the disease.

If the lunate has already started to collapse and break it can be removed with the proximal row carpectomy procedure. The two bones neighboring the lunate must also be removed and will relieve pain and preserve limited mobility. Another option to ease pressure is fusion to make the nearby wrist bones one bone together. The procedure preserves some wrist motion and reduces pain. Many degrees of fusion can be done depending on the severity.