Kienbock’s Disease

Kienbock’s disease treatment Sydney

Kienbock’s disease is a condition that affects the blood supply to one of the carpal bones, which are the small bones of the wrist. It causes symptoms like wrist pain and stiffness, and if left untreated, it tends to get worse over time. Treatment is easier when started earlier in the course of the condition, so it’s a good idea to seek medical attention as quickly as possible if you notice any symptoms. However, there are still effective treatment options for those who have been experiencing Kienbock’s disease for many years.

What is Kienbock’s disease?

Kienbock’s disease affects the lunate, which is one of the carpal bones. There are eight of these small, irregularly-shaped bones located in the wrist. They’re arranged in two rows of four bones each; the proximal row is the one that’s closer to the arm, while the distal row is closer to the fingers. The bones in the proximal row form the wrist joint along with the radius, which is one of the long bones of the forearm.

The lunate is one of the carpal bones in the middle of the proximal row. In people with Kienbock’s disease, there’s an interruption of the blood supply to the lunate. Without enough blood supply, the bone tissue dies. This process is known as avascular necrosis. The damage to the lunate leads to wrist pain and dysfunction.

Who is at risk for Kienbock’s disease?

In general, Kienbock’s disease is relatively rare. However, people with certain risk factors are more likely to develop this condition. These risk factors include:

• Wrist injuries. A significant injury to the wrist can damage the blood vessels that supply the lunate with blood.
• Repetitive stress. Repeated impacts or pressure on the wrist can damage the blood vessels of the lunate over time, leading to Kienbock’s disease. This may occur in people who perform manual labor or those who play certain sports.
• Anatomical variations. The anatomy of the wrist varies from one person to another, and some variations can lead to Kienbock’s disease. For example, in some people, one of the bones of the forearm is shorter than the other, which creates uneven pressure on the lunate and can affect its blood supply. The lunate also usually has two blood vessels supplying it with blood, but in some people, it only has one blood vessel. This makes the lunate’s blood supply more vulnerable, which increases the risk of Kienbock’s disease.
• Medical conditions. Certain medical conditions that affect blood flow throughout the body increase the risk of Kienbock’s disease. These include lupus and sickle cell anemia. Similarly, long-term use of strong anti-inflammatory medications like prednisone can also increase risk.
• Age and gender. Younger men (between ages 20 and 40) are most at risk for developing this condition.

What are the symptoms of Kienbock’s disease?

Kienbock’s disease most commonly affects a person’s dominant side, meaning that right-handed people will usually experience symptoms in their right wrist, while left-handed people will feel the symptoms in their left wrist. Symptoms may include:

• Pain and tenderness around the center of the wrist
• Wrist stiffness
• Decreased ability to move the wrist
• Wrist swelling
• A crackling or popping sound when you move the wrist
• Instability of the wrist
• Loss of grip strength

Kienbock’s disease is not the only potential cause of these symptoms. Your doctor may use X-rays, a CT scan, and/or an MRI of your wrist in order to arrive at a diagnosis.

How is Kienbock’s disease treated?

In general, Kienbock’s disease is a progressive condition. Without treatment, the symptoms will usually continue to get worse over time. However, there are a variety of treatment options that can help to manage symptoms and improve wrist function.

In the early stages, it may be possible to restore the blood supply to the lunate, allowing the tissue to repair itself. There are a few different ways of doing this:

• Immobilization. In mild cases, immobilizing the wrist in a cast or splint for a period of time gives the lunate a chance to restore its blood supply. Anti-inflammatory medications (either oral or injected) may help to manage symptoms and help improve blood supply. Occupational therapy is also helpful, so you can learn to adjust your movement patterns to reduce pressure on the wrist. While immobilization may be effective in children and adolescents, it’s much less likely to be effective in adults, and is only used in cases where the symptoms are very mild.
• Revascularization surgery. This involves taking a small piece of bone tissue, along with its blood supply, from a different bone, and implanting it into the lunate. The donor bone is usually a nearby bone of the hand, wrist, or forearm. In some cases, a more distant bone can be used as the donor bone (such as the thigh bone), and then microsurgical techniques are used to reconnect the blood vessels. The grafted bone tissue helps to restore blood supply to the lunate. It’s necessary to immobilize the wrist for a period of time while the graft heals, as the new blood supply is fragile at first.
• Joint leveling surgery. If the two bones of the forearm (the ulna and radius) are of different lengths, then surgery to correct this issue may help. This is known as joint leveling, and it may involve shortening the radius or lengthening the ulna. It can help to reduce the pressure on the lunate and stop the condition from progressing.

Procedures that restore the lunate’s blood supply are only effective if the lunate is still relatively healthy and able to recover. When the lunate doesn’t get enough blood supply for a long period of time, the bone tissue will start to die off, and the bone will eventually collapse. The cartilage on the outside of the lunate may also start to wear away. Once this has happened, restoring blood flow will not be effective, as the tissues are too damaged to heal. Instead, surgery aims to restore as much wrist function as possible. Options include:

• Proximal row carpectomy. This involves removing the damaged lunate and the two adjacent carpal bones. The remaining carpal bones will then form a new joint with the radius (the bone of the forearm). This provides pain relief and generally improves wrist function. Although the wrist may have a reduced range of motion after the procedure, many patients are able to return to their previous activities.
• Wrist fusion. This procedure involves surgically fusing the bones of the wrist together so that they can’t move anymore. This relieves symptoms like pain and instability in the wrist, but it also completely eliminates movement at the joint. Patients must then relearn how to manage their daily activities with a wrist that cannot move.
• Wrist replacement. For patients who prefer not to have their wrist immobilized, wrist replacement is an alternative to wrist fusion. Instead of fusing the bones of the wrist together, the damaged parts of the wrist joint are replaced with artificial joint surfaces. This procedure generally allows the wrist to be relatively mobile and functional for most activities, and is also effective at relieving symptoms like pain.

Kienbock’s disease treatment Sydney

If you’re experiencing wrist pain, it’s important to be evaluated by a qualified medical professional. There are many potential causes of wrist pain, and Kienbock’s disease is one of them. For some conditions, early treatment is important to prevent future complications, so it’s best not to delay seeking medical care.

As a highly trained expert in the field of hand and wrist surgery, Dr. Sungaran has many years of experience in treating Kienbock’s disease. He stays up-to-date on the latest surgical techniques, because he’s committed to giving his patients the best possible outcomes. If you’ve been diagnosed with Kienbock’s disease, or if you’re experiencing wrist pain that could indicate that you have this condition, we invite you to make an appointment for a consultation with Dr. Sungaran. Simply contact our friendly front desk staff to schedule your appointment.