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Kienbocks Disease

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What is Kienbocks Disease?

Kienbocks disease is a condition in which there is a limitation in the blood supply to a small bone in the wrist, called the lunate, found in the middle of the wrist connected to the radius arm bone.

This condition can result in death of the lunate bone (osteonecrosis).

In the late stages of the disease, the bone collapses, shifting the position of other bones in the wrist. This shifting eventually leads to degenerative changes and osteoarthritis in the joint.

Kienbocks disease

What are the symptoms of kienbocks disease?

Kienbocks disease

Some common symptoms of Kienbocks disease include:

  • Pain in wrist

  • Loss of grip strength in the hand

  • Loss in range of motion

  • Swelling in wrist

Factors that Cause Kienbocks Disease

There is no evidence that Kienbocks disease is inherited, but genetic factors may play a role. Kienbocks disease does not appear to have a single cause, but it probably stems from multiple factors:

  • Problems with arterial blood supply. Most people have two blood vessels supplying blood to the lunate bone, but some have just one.
  • Blood does not drain away properly through the veins.
  • Trauma may affect blood supply, for example, a single blow to the wrist.

Another cause could be that the ulna, the long bone in the forearm, is shorter than normal. If the ulna and radial bones are different lengths, this may put extra pressure on the lunate in certain wrist motions. This extra stress could lead to Kienbocks disease.

Diseases that may increase the risk include lupus, cerebral palsy, sickle cell anemia, and gout.One study found that 9.4 percent of patients with cerebral palsy also had Kienbocks disease

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Diagnosing Kienbocks Disease

Most people who have Kienbocks disease live with the condition for months or years until the until the symptoms become problematic, and they seek help. Patients normally approach the doctor with wrist pain.

The doctor will ask about symptoms, medical history, previous trauma, and how long the person has had the symptoms. They will also examine the hand and wrist.

Kienbocks disease may be difficult to diagnose accurately in the early stages, because the signs and symptoms resemble those of many other conditions, such as wrist sprain and any cause of arthritis.

To diagnose Kienbocks disease, the experts at NSOC will examine a patient’s wrist, carefully review X-rays and recommend appropriate treatment based on severity.

An MRI scan can help to assess the blood supply to the lunate.

In the later stages, an x-ray will reveal the damage, and a CT scan may be able to determine the number and sizes of the bone fragments.

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What are the treatment options for Kienblock’s disease

Kienbocks disease

Non-surgical Treatment Options

There is no cure for Kienbock’disease, but there are treatments options that can help restore the blood supply and maximize wrist function and reduce pain.

During the early stages, it might be possible to splint and cast the wrist for several months. Resting the wrist increases the chance of restoring blood flow to the lunate bone.

If caught in an early stage, anti-inflammatory medication (such as ibuprofen) may be recommended in addition to a splint or cast. If the pain persists or returns, surgery may be advised.

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Surgical Treatment Options

  • Revascularization surgery: This involves grafting a piece of healthy living bone to the diseased lunate and is most successful in the early stages of Kienbock’s disease. This surgery can return blood flow to the lunate bone after a healthy piece of bone from the pelvis or radius is transplanted to the lunate. Internal pins may be used to secure the bones and grafts in place while they heal.

  • Joint leveling surgery: This is performed to prevent damage to the lunate bone by making the ends of the two arm bones (radius and ulna) the same length. Having bones the same length can reduce pressure on the lunate, alleviating pain and restoring critical blood flow. A short bone can be extended by attaching a graft, from the patient’s pelvic bone or radius, to the end of the short bone. A bone that is too long can be shaved down to the appropriate length.

  • Joint fusion: Another surgical option is a bone fusion. This involves fusing some or all bones in the wrist, depending on severity of the damage. This surgery may involve a bone graft, pins or a plate to hold the necessary bones together as one.

  • Lunate removal: In advanced cases of Kienbock’s disease, the lunate and two small bones on either side are removed. This reduces pain and allows for continued use of the wrist. It is usually performed when the lunate has collapsed or deteriorated and is no longer functional. Occasionally, only the lunate is removed and a titanium or silicone implant can be put in its place.

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