Kienbock’s Disease

What is Keinbock’s Disease?

A condition where the blood supply to the lunate (one of the small bones in the wrist) gets interrupted. The bones require regular blood supply for nourishment. A bone can die without blood supply. The condition when bones dies due to the absence of blood supply, the condition is called osteonecrosis. Damage to the lunate causes pain and stiffness in the wrist. It may even result in arthritis.

What causes Kienbock’s disease?

The exact cause of the disease is still unknown. During the first stages of the disease, the patient may have a sprain like experience in the wrist. The patient might have had any form of trauma to the wrist. It may cause disruptiion  in the blood flow to the lunate.

Kienbock’s disease symptoms:

Common signs and symptoms of Kienbock’s disease are:

Wrist pain
Swelling in the wrist
Stiffness or limited movements of the wrist
Decreased grip strength in the hand
Tenderness of the bone
Pain and difficulty when turning the hand upward

Diagnosing Kienbock’s disease:

The doctor will first analyze the medical history of the patient. He/she will then have a physical examination. The doctor may also suggest and X-ray or an MRI or both to confirm the condition.

Kienbock’s disease treatment:

Kienbock’s disease cannot be completely cured. However, there are various nonsurgical and surgical treatments to relieve the pressure on the lunate bone and restore the blood flow.

Nonsurgical Treatment:

Anti-inflammatory medications can be used in the early stages to reduce the swelling and inflammation. Immobilizing the wrist can also help in reducing the pressure if the lunate. Using a splint or cast for 2-3 weeks may also be recommended. The doctor will monitor the changes in symptoms during the treatment period. If nonsurgical treatment options couldn’t relieve the pain and swelling, the doctor may suggest for a surgery.

Surgical Treatment:

Several surgical treatment options are there for Kienbock’s disease. The progression of the disease is a major factor in determining the exact method. Some of the common surgical options include:

Revascularization: The procedure by which returning the blood supply to the lunate bone is called revascularization. It is usually suggested during the first stages of the condition. It may not be successful when the lunate has deteriorated significantly. During the procedure, a portion of bone that is attached with another blood vessel from another bone will be removed. This piece of bone called vascularized graft will be inserted into the lunate bone.

Joint leveling: A joint leveling procedure is recommended if the two bones of the lower arm are not of the same length. The bones can make longer using grafts and can shorten by removing a portion of the bone. This procedure can prevent the progression of the disease.
Proximal row carpectomy: Severely collapsed lunate can be removed through this procedure. Two bones of either side of the lunate may also be removed during this procedure. The procedure is beneficial to relieve the pain and maintain partial wrist motion.

Fusion: Bones near the wrist bones are fused together into a solid bone during this procedure. The procedure helps to ease the pressure on the lunate, relieve pain and maintain wrist motion. In severe cases, all the wrist bones are fused to the radius. It will help in relieving the pain and restoring the hand function.

Success of any treatment depends on the severity and rate of progression of the disease. The response to treatment may vary in each patient.

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