Kienbock’s disease is a rare condition caused by a lack of blood flow to one of the bones of the wrist. This is most commonly seen in people between the ages of 20 and 40 and can be extremely painful and debilitating.
The disease progresses slowly because the bone isn’t as susceptible to blood loss as tissue or muscles are. It may start as a tightening and swelling of the wrist as the bone begins to harden, but once the bone begins to die and splinter, the pain can be unbearable.
Kienbock’s disease is caused by the loss of blood supply to the lunate. The lunate is one of the eight small bones that make up the “carpal bones” in the wrist.
There are two rows of bones in the wrist: the proximal row, located closer to the forearm, and the distal row, which is closer to the fingers. The lunate bone is in the center of the proximal row. It is next to the scaphoid bone, which spans the two rows.
There is probably no single cause for loss of blood supply to the lunate. The cause of Kienbock’s disease seems to involve multiple factors. These factors include the blood supply (arteries), the blood drainage (veins), and skeletal variations.
Skeletal variations associated with Kienbock’s disease include a shorter length of the ulna, one of the forearm bones, and the shape of the lunate bone itself. There may be some cases that are associated with diseases like gout, sickle cell anemia, and cerebral palsy.
Trauma, either a single event or repeated significant trauma, may affect the blood supply to the lunate. In general, though, Kienbock’s disease is not felt to be related to occupational hazards.
However, the presence of Kienbock’s disease can affect the treatment and prognosis for traumatic events.
Kienbock’s disease treatment depends on the severity and stage of the disease.
In very early stages, the treatment can be as simple as observation or immobilization. For more advanced stages, surgery is usually considered to try to reduce the load on the lunate bone by lengthening, shortening, or fusing various bones in the forearm or wrist.
Sometimes bone grafting or removal of the diseased lunate is performed.
If the disease is very advanced and the relations of the bones from one to the other have markedly deteriorated, complete wrist fusion may be the treatment of choice.
Hand therapy does not change the course of Kienbock’s disease, but it may help to minimize the disability from the problem. Treatment is designed to relieve pain and restore function.
Our hand doctor will advise you of the best treatment options for you, as well as explain the risks, benefits, and side effects of various treatments for Kienbock’s disease.
The results of Kienbock’s disease and its treatment vary considerably depending on the severity of the involvement, as well as whether or not the disease progresses. The disease process and response to treatment will take several months. On occasion, several forms of treatment, and even multiple operations, might be necessary.
If you believe you are experiencing symptoms of Kienbock’s disease, make an appointment to see our hand surgeon in West Bloomfield, Howell, Warren, or Macomb Township.
