Kienbock's Disease

I got the results of the MRI on my wrist yesterday.  Diagnosis:  Kienbock's Disease.
 I was referred to a hand surgeon here in town for treatment options.   I'm most likely in stage 2-3 as the lunate bone has already fractured and the xray and mri showed the bone beginning to die.   I've had pain in my wrist for about 3 years, but chalked it up to repetitive movement caused by picking up my infant then toddler then infant again.  Over the last month i've lost considerable range of motion ... thus the trip to the dr.  

What is Kienbock’s Disease?
Kienbock’s disease, or avascular necrosis of the lunate, is a condition in which the lunate bone, one of eight small carpal bones in the wrist, loses its blood supply, leading to death of the bone.  The lunate is a central bone in the wrist, important for proper movement and support of the joint.

What is its course?
The progression of Kienbock’s disease varies but is usually slow over many years. There are 4 stages used to classify Kienbock’s disease. In stage 1, x-rays appear normal, but the lunate has lost its blood supply and is painful and may fracture. In stage 2 the bone hardens due to lack of blood supply and appears abnormally dense on X-ray. In stage 3 the bone collapses and fragments. In the final stage, stage 4, the lunate is collapsed and the bones around the lunate have developed degenerative changes and become arthritic. In the early stages there may be only pain and swelling, but as the disease progresses the mechanics of the wrist become altered, which puts abnormal stresses and wear on the joints within the wrist itself.

What are the treatment options?Treatment options depend upon 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 forces on the lunate bone by lengthening, shortening, or fusing various bones in the forearm or wrist. Surgery can also be aimed at trying to restore blood supply to the lunate (revascularization), using a bone graft with a blood vessel attached to it. This is not an option in more advanced stages if the relationship of the bones has markedly deteriorated; complete wrist fusion may then be the preferred treatment.
Hand therapy does not change the course of the disease; however, hand therapy can help to minimize the disability from the problem. Treatment is designed to relieve pain and restore function.

Your hand surgeon will advise you of the best treatment options and explain the risks, benefits, and side-effects of various treatments for Kienbock’s disease.

What can I expect?
The results of Kienbock’s disease and its treatment vary considerably, depending on the severity of the involvement, and whether or not the disease progresses. The disease process and response to treatment can take several months. On occasion, several forms of treatment, and even multiple operations, might be necessary.

Figure 1:  Normal wrist


Figure 2:  Wrist with Kienbock’s disease and ulna that is short compared to radius

Figure 3: MRI of a wrist with Kienbock’s disease showing loss of blood supply to the lunate in a patient with a short ulna
© 2006 American Society for Surgery of the Hand