What is Kienbock's disease?
Kienbock's disease is a condition in which there is a limitation in the blood supply to a small bone in the wrist, called the lunate, found in the middle of the wrist connected to the radius arm bone. This condition can result in death of the lunate bone (osteonecrosis). This condition is unusual and can be caused by trauma to the wrist which disrupts the blood flow to the lunate. In some cases, a patient may have unusual anatomy which is thought to predispose the condition. These cases are known to have "negative" ulnar variance and may cause pressure and loss of blood flow to the lunate. Kienbock's generally affects younger people and causes a painful, swollen wrist that can lead to arthritis. To diagnose Kienbock's disease, the experts at Midwest Orthopaedics at Rush Hand, Wrist & Elbow Institute will examine a patient's wrist, carefully review X-rays and recommend appropriate treatment based on severity.
What are the symptoms of Kienbock's disease?
Some common symptoms of Kienbock's disease include:
- Pain in wrist
- Loss of grip strength in the hand
- Swelling in wrist
- Loss in range of motion
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.