Kienbock's Disease
Keinbock's disease — also referred to as avascular necrosis (AVN) — causes osteonecrosis, a process in which the lunate bone in the wrist slowly loses blood supply and breaks down. Keinbock's disease often occurs in adult men from 20-40 years old but can occur in anyone at any age.
What You Need to Know About Kienbock's Disease
What is Kienbock's Disease?
Kienbock's disease occurs when blood supply to the lunate bone in the wrist becomes interrupted, causing the bone to deteriorate and die. The lunate bone is a small carpal bone that works with two forearm bones—the radius and ulna—to allow movement and support.
When the bone begins to collapse, you may feel pain and stiffness in the wrist and experience a decrease in strength. Arthritis of the surrounding bones may also occur over time.
There are four stages of Kienbock's disease:
Stage 1: You may feel wrist pain from an unknown cause. This is caused by the decreased blood supply to the bone.
Stage 2: The lunate bone hardens because of limited blood flow. This process is called sclerosis.
Stage 3: The hardened lunate begins to break, which may cause the surrounding bones to move. You may experience an increase in pain, movement limitations, and weakness.
Stage 4: The other wrist bones weaken because they do not have the support of the lunate, and your wrist may become arthritic.
The progression through all the stages of Kienbock's disease may take several months or years.
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What Causes Kienbock's Disease?
Kienbock disease often occurs in adult men between 20-40 years old, but it can arise at any age. The exact cause of Kienbock's disease is unknown, but various factors may lead to your lunate bone breaking down, including:
Decrease in blood flow: Bones die if they do not receive nourishing blood. The process of bone dying is called osteonecrosis.
Irregular skeletal variations: An irregularly shaped lunate bone can increase the risk for complications. Increased pressure on the lunate can also occur if the ulna and radius bones are not the same length.
Trauma to the bone: A high-impact event or multiple accidents may disrupt the blood flow to the lunate.
Blood disorders: Disorders that affect the blood — including lupus or sickle cell anemia — may increase the risk for Kiendock's disease.
Kienbock's Disease Symptoms
Patients with Kienbock's disease often exhibit the following symptoms:
- Swelling over the lunate bone
Wrist pain
Tenderness over the lunate bone
Wrist stiffness or decreased range of motion
Decreased grip strength
Kienbock's disease symptoms can range from mild to severe and present like other hand and wrist conditions. If the pain does not improve or worsens, you should schedule an appointment with a doctor.
How is Kienbock's Disease Diagnosed?
Kienbock's disease is diagnosed by reviewing your medical history, examining your wrist, and using diagnostic imaging—including X-ray, MRI, CT, or bone scans—to assess blood supply and bone density.
Kienbock's disease progresses through four stages over months or years. Your doctor will confirm the disease and review the best treatment options to improve the condition.
Kienbock's Disease Treatment
There is no complete cure for Kienbock's disease, but non-surgical and surgical treatment options can help relieve the pressure on the lunate and increase blood flow to the bone.
Non-Surgical Treatment
Non-surgical options can help treat the disease in its early stages. These treatments can include:
- Taking anti-inflammatory medications to reduce pain and swelling
Immobilizing the wrist to decrease pressure on the lunate
Splinting or prolonged casting
Non-surgical treatments do not stop the disease's progression. Monitoring the symptoms in the early stages can help your doctor assess the success of non-surgical treatments. If the symptoms persist, your doctor may explore surgical options.
Surgical Treatment
Kienbock's disease surgery can help resolve the pain if conservative treatments fail. The disease's progression will determine which procedure is most appropriate.
Surgical procedure options include:
Revascularization: Restoring blood flow to the lunate bone. This is most successful in stages 1 and 2—before the bone has fragmented or collapsed.
Joint leveling: Uneven ulna and radius bones can be leveled by using bone grafts or bone removal. Leveling the bone can reduce the pressure compressing the lunate, stopping the disease's progression.
Proximal row carpectomy: A broken or severely collapsed lunate can be removed. Removing the bone can reduce pain and restore partial movement in the wrist.
Fusion (arthrodesis): Fusing the other wrist bones to make one bone can relieve pressure on the lunate bone.
Resurgens Hand and Wrist Center is the leading treatment provider in Georgia. Find relief by booking an appointment at one of our world-class facilities.