Hand Doctors in Houston - Kienbock's Disease

AN OVERVIEW OF KIENBOCK'S DISEASE

Kienbock’s disease affects the blood supply to the lunate, a small bone in the wrist. This condition causes pain, swelling, and limited mobility in its early stage. If allowed to progress, collapse of the bone may occur and other area bones may be affected. Kienbock’s disease progresses in four stages:

• Stage One: symptoms which mimic wrist sprain develop.
• Stage Two: hardening of the lunate bone.
• Stage Three: lunate bone deterioration begins.
• Stage Four: surface of nearby bones are affected. Arthritis may develop.

Symptoms Include:

• Pain and swelling in the wrist.
• Stiffness and limited range of motion.
• Weakened grip strength.

Early diagnosis is often difficult, due to the similarity of symptoms with wrist sprain. X-rays often appear normal during the initial stage of the disease. As the condition progresses, signs begin to appear on X-rays and MRI.

Treatment Options

During the initial stage of the disease, treatment options include immobilization and anti- inflammatory medications to reduce swelling and pain. If symptoms persist, or if the disease has progressed to the later stages, several surgical options are available. Which option is used depends upon the stage of the disease as well as the patient’s activity-level and goals. Available surgical options include:

• Bone grafting: to restore blood supply to the area.
• Joint Leveling: used when the bones in the forearm are uneven, causing pressure on the lunate.
• Proximal Row Carpectomy (removal of deteriorated bones in the wrist): to relieve pain and swelling while maintaining partial mobility.
• Bone Fusion: used in severe cases after wrist bones have deteriorated. This procedure offers relief from pain and swelling, though range of motion in the wrist will be limited.