Fact: Kienböck's Disease is an acquired bone disorder
What is Kienböck's Disease?
Kienböck's disease is a condition where the blood supply to one of the small bones in the wrist, the lunate, is interrupted.
Bone is living tissue that requires a regular supply of blood for nourishment. If the blood supply to a bone stops, the bone can die. This is called osteonecrosis.
Damage to the lunate causes a painful, stiff wrist and, over time, can lead to arthritis.
The cause of Kienböck's disease is not known. Many people with Kienböck's disease think they have a sprained wrist at first. They may have experienced some form of trauma to the wrist, such as a fall. This type of trauma can disrupt the blood flow to the lunate.
Some things may put you more at risk for the disease. For example, most people have two vessels that supply blood to the lunate, but in some people there is only one source. This may slow the blood flow to the bone. In addition, if the two bones of the forearm (the radius and ulna) are different lengths, extra pressure can be put on the lunate during some wrist motions. Over time, this extra stress on the bone may lead to Kienböck's disease
Kienböck's disease is a condition that progresses slowly, and many people do not decide to see a doctor until they have lived with symptoms for several months, perhaps longer.
During the first stage of the disease, the symptoms are similar to those of a wrist sprain. Although the blood supply to the lunate has been disrupted, x-rays may still appear normal or suggest a possible fracture. An MRI scan can better detect blood flow and is helpful in making the diagnosis in this early stage.
The lunate bone begins to harden due to the lack of blood supply during Stage 2. This hardening process is called sclerosis. In addition, the lunate will appear brighter or whiter in areas on x-rays, which indicates that the bone is dying. To better assess the condition of the lunate, your doctor may also order either MRI scans or computed tomography (CT) scans.
The most common symptoms during this stage are wrist pain, swelling, and tenderness.
In Stage 3, the dead lunate bone begins to collapse and break into pieces. As the bone begins to break apart, the surrounding bones may begin to shift position.
During this stage, patients typically experience increasing pain, weakness in gripping, and limited wrist motion.
If the condition progresses to Stage 4, the surfaces of the bones surrounding the lunate also deteriorate, and the wrist may become arthritic
What are the treatment options for Kienbock's disease?
Non-surgical Treatment Options
There is no cure for Kienbock's disease, but there are treatments options that can help restore the blood supply and maximize wrist function and reduce pain. If caught in an early stage, anti-inflammatory medication (such as ibuprofen) may be recommended in addition to a splint or cast. If the pain persists or returns, surgery may be advised.
Surgical Treatment Options
Surgical treatment depends on the severity of the condition. A physician may recommend one of the following options:
- Revascularization surgery: This involves grafting a piece of healthy living bone to the diseased lunate and is most successful in the early stages of Kienbock's disease. This surgery can return blood flow to the lunate bone after a healthy piece of bone from the pelvis or radius is transplanted to the lunate. Internal pins may be used to secure the bones and grafts in place while they heal.
- Joint leveling surgery: This is performed to prevent damage to the lunate bone by making the ends of the two arm bones (radius and ulna) the same length. Having bones the same length can reduce pressure on the lunate, alleviating pain and restoring critical blood flow. A short bone can be extended by attaching a graft, from the patient's pelvic bone or radius, to the end of the short bone. A bone that is too long can be shaved down to the appropriate length.
- Lunate removal: In advanced cases of Kienbock's disease, the lunate and two small bones on either side are removed. This reduces pain and allows for continued use of the wrist. It is usually performed when the lunate has collapsed or deteriorated and is no longer functional. Occasionally, only the lunate is removed and a titanium or silicone implant can be put in its place. This is rare due to the high occurrence of it slipping out of place, causing excruciating pain.
- Joint fusion: Another surgical option is a bone fusion. This involves fusing some or all bones in the wrist, depending on severity of the damage. This surgery may involve a bone graft, pins or a plate to hold the necessary bones together as one. Loss of wrist function is likely with fusion, such as bending the wrist, but it may preserve some of the hand functions like forceful grasping of objects.
Want to learn more?
The following are organizations and/or websites dedicated to providing information and education surrounding Kienböck's Disease. These organizations are dedicated to research, education, awareness, and/or support. They are listed in Alphabetical order without any preference or prejudice. Listing these organizations is not a recommendation or referral in any regard for seeking treatment or consultation or support for treatment.
American Academy of Orthopaedic Surgeons
American Society for Surgery of the Hand
Midwest Orthopaedics at Rush
National Organization for Rare Disorder