Ask a Doctor: Kienbock’s Disease

Dr. Mark Yuhas answers your questions about Kienbock’s Disease:

What is Kienbock’s Disease?

Kienbock’s Disease, also known as avascular necrosis of the lunate, is a disease that can result in pain and stiffness in the wrist. The lunate is one of eight small bones in the wrist that give the wrist its complex and unique motion.  “Avascular necrosis” is a lack of blood supply to the bone, which results in bone death. Blood supply is important to all bones to grow, heal, and provide structure and support to the body. Without blood supply, the lunate may not provide the same support and structure needed for proper wrist function.

What is the cause of Kienbock’s Disease? Can it be prevented?

There are several theories about the cause of Kienbock’s Disease, but a single cause has not been identified. Multiple variables are thought to be involved, including a history of wrist trauma. Other contributing factors include variations in anatomy such as the position of the forearm bones at the wrist, the shape of the lunate, and the pattern of blood supply to the lunate. Most of these factors are not able to be controlled by the patient.

There is no way that we know to prevent Kienbock’s Disease. However, it is important to identify this problem as soon as possible in order to prevent progression of the disease which can lead to wrist arthritis. This ultimately can cause pain, stiffness, and decreased function in the wrist.

How do I know if I have Kienbock’s Disease?

Some typical symptoms for a patient with Kienbock’s Disease include pain and swelling in the wrist, usually on the dorsal (opposite of palm) aspect of the wrist joint. Other symptoms may include decreased strength with gripping, wrist pain with activity, and wrist stiffness.

The problem most often affects males between 20-40 years of age, but females can be affected, and people of all ages can be affected. Pain may be present for months or even years before a diagnosis is made, and early diagnosis can be challenging.

Many other disorders of the wrist can present with similar symptoms, so it is important to discuss these symptoms with a hand specialist to aid in making a diagnosis.

What should I expect when I go to see a hand specialist?

If you have symptoms and a history suspicious for Kienbock’s Disease, further testing will need to be performed. This will typically start with x-rays of the wrist. If there is further uncertainty, or to help with diagnosis and staging the problem, an MRI or CT scan of the wrist is often helpful as well.

Kienbock’s Disease is often classified in “stages” based on the amount of time the lunate has been without blood supply, among other factors. As the lunate loses blood supply, the shape and strength of the bone may change, leading to further changes in the wrist, such as arthritis (loss of smooth cartilage that helps the joint move).

The “stage” of Kienbock’s Disease can be determined with imaging such as x-ray, MRI, and CT scan. This information can help a physician to guide a patient’s treatment options.

What are the treatment options for Kienbock’s Disease?

There are multiple treatment options for Kienbock’s Disease. These options are usually determined by the “stage” or progression of the change in the lunate.

The earliest stages of lunate avascular necrosis may sometimes be treated with nonoperative care. This can involve a wrist brace and promoting rest of the joint and anti-inflammatory medications such as ibuprofen or aspirin.

Often, nonoperative treatment is not effective for this problem and surgical options need to be discussed. Talking with your hand specialist about treatment options is important, as multiple options may be appropriate. Factors that a surgeon may consider in treating a wrist with Kienbock’s Disease include the “stage” of lunate avascular necrosis (such as collapse of the bone or surrounding arthritis in the wrist), age and function of the patient, and the position of the forearm bones relative to each other (also known as ulnar variance).

No matter the treatment, it can be difficult to treat Kienbock’s Disease. Improvement in function, pain, and motion can be achieved with surgery, but expectations should be discussed with your surgeon.

Dr. Mark Yuhas is an Orthopaedic Surgeon who specializes in Hand, Wrist, and Elbow care. He practices with Wellington Orthopaedic and Sports Medicine/ Mercy Orthopaedics and Sports Medicine in Cincinnati, OH. His current interests include trauma of the hand, wrist, and elbow; sports injuries of the upper extremity; and arthritis throughout the hand and wrist.

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