Kienbock's Disease 

Introduction

Kienbock’s disease is a progressive condition that affects the lunate bone in the wrist.  It occurs when there is disruption in the blood supply to the lunate bone.  The exact cause of Kienbock’s disease is unknown.  It occurs when there is disruption in the blood supply to the lunate bone.  Without a blood supply, the lunate bone decays and dies.  Kienbock’s disease can eventually affect the structure and function of the wrist.

Blood flow to the lunate bone may be disrupted by trauma, such as a fall.  Overuse of the dominant hand is suspected to contribute to Kienbock’s disease.  People that are born with just one artery to supply the lunate, instead of two, are at risk for developing Kienbock’s disease.

Kienbock’s disease affects more men than women.  It most frequently develops in individuals between the ages of 20 and 40 years old.  It appears to develop more commonly in the dominant hand.
Without a proper blood supply, the lunate bone decays and dies.  Kienbock’s disease can eventually affect the structure and function of the wrist.  Treatment for Kienbock’s disease includes immobilization, anti-inflammatory and pain medications, therapy, and surgery.

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Anatomy
The lunate bone is one of the small bones in the wrist.  The lunate bone is part of the proximal carpal row.  It is part of the radiocarpal and midcarpal joints.  The midcarpal joint allows your hand and wrist to move upwards and towards the thumb side.  The radiocarpal joint allows you to lower your hand and wrist and move it towards the little finger side of your hand.

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Causes
The exact cause of Kienbock’s disease is unknown.  It occurs when the blood supply to the lunate bone is disrupted. Your bones need blood to live.  Without a blood supply, the lunate bone  decays and dies. Kienbock’s disease can eventually affect the structure and function of the wrist.

Blood flow to the lunate bone may be disrupted by trauma, such as a fall.  Overuse of the dominant hand is suspected to contribute to Kienbock’s disease.  People that are born with just one artery to supply the lunate, instead of two, are at risk for developing Kienbock’s disease.

Kienbock’s disease affects more men than women.  It most frequently develops in individuals between the ages of 20 and 40 years old.  It appears to develop more commonly in the dominant hand.

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Symptoms
The initial symptom of Kienbock’s disease is pain.  Kienbock’s disease can cause your wrist to feel painful, stiff, and tender.  Your wrist may appear swollen.  You may not be able to move your wrist as far as you used to be able to.  Your hand and grip strength may become weaker, making it difficult for you to hold objects.  
 
Kienbock’s disease is a progressive condition, meaning that it can get worse over time.  As the lunate bone degenerates, symptoms may become worse.  Kienbock’s disease can lead to arthritis and loss of wrist function.

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Diagnosis
Your doctor can diagnose Kienbock’s disease by examining your wrist and conducting tests.  You should tell your doctor about your symptoms and any recent trauma to your hand.  Your doctor will take an X-ray of your wrist.  X-rays may be normal during the initial stages of Kienbock’s disease.  A MRI scan or CT scan may be used to show more detailed images.
 
Your doctor will determine what stage your Kienbock’s disease is in.  The condition specifically progresses through four stages.  In the first stage, x-ray may be normal and symptoms are similar to a sprained wrist.  In stage two, the lunate bone hardens.  This can be seen on x-ray.  Pain, swelling, and tenderness increase.  In the third stage, the lunate bone collapses and breaks into pieces.  The other bones in the wrist may shift position as the lunate bone deteriorates.  People with stage three Kienbock’s disease experience an increase in symptoms plus grip weakness and limited movement of their wrist.  In the final stage of Kienbock’s disease, the surfaces of nearby bones are affected, and arthritis develops in the wrist.

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Surgery
There are several surgical options for Kienbock’s disease.  The most appropriate choice for you depends on the stage of your condition, your activity level, and your expected outcome.  Your surgeon will discuss options with you.  In some cases, the blood supply can be surgically restored to the lunate bone.  This type of procedure is called revascularization surgery.  In another surgical procedure, lengthening or shortening the lower arm bones can reduce the pressure on the lunate.  Bones are made longer with bone grafts.  Bones are made shorter by removing a section of the bone.  These are referred to as joint leveling procedures. 
 
A severely damaged lunate bone can be removed.  The bones on each side of the lunate may also be removed in a procedure called a proximal row carpectomy.  This surgery can help to relieve pain while allowing partial wrist movement.
 
Another type of surgery involves fusing, a procedure that connects several small bones in the wrist.  Fusion can relieve pressure on the lunate.  Fusion does not improve wrist movement.  If arthritis is present, fusion can help relieve pain and maintain the wrist movement that you have.

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Treatment
The treatment that you receive will depend on the stage of Kienbock’s disease that you have.  For beginning stages, splints or casts may relieve pressure on the lunate and restore the blood flow.  Medications may help ease pain and reduce swelling.  More advanced stages of Kienbock’s disease may be treated with surgery.
 
You may be referred to a therapist for rehabilitation following surgery.  A therapist can teach you exercises to help you gain motion, flexibility, strength, and coordination in your hand.  Exercises will be used in conjunction with modalities, such as heat, ultrasound, Fluidotherapy and others, to increase blood flow and assist tissue healing.  If you have limitations because of your condition, a therapist can help you make the most of the movements that you do have and recommend assistive devices to help you perform activities as independently as possible.

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Recovery
Kienbock’s disease is a progressive condition that gets worse over time.  There is no cure for Kienbock’s disease.  However, surgical and nonsurgical treatments can relieve symptoms, maintain motion, and sustain wrist function.

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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.