Kienböck's disease

What is Kienböck’s disease?

Kienböck’s disease is a very rare condition that causes your bone tissue to die off, resulting in pain and immobility in your wrist. It stops the blood supply to the lunate – a crescent-shaped bone that is one of eight carpal bones, which helps you to move your wrist.

While Kienbock’s is rare, you are more at risk of developing it if you suffer from any sort of blood disorder, such as lupus or sickle cell anaemia. There are a number of factors which may also contribute to Kienbock’s disease including:

Trauma to the bone through an accident
Reduced blood flow to the bone, which can cause the bone to die
A misshapen lunate bone

You may not have any symptoms and often, Kienbock’s disease is only discovered during diagnostics for another condition, for example if you were having an MRI or CT scan for another wrist complaint. Some more obvious symptoms may include:

Sharp pain in the wrist
Pain over the centre of your wrist
Swelling and stiffness
Weakness in grip and strength
Cracking and/ or grating sounds when moving your wrist

The exact cause of Kienbock’s disease is not known, however it is more common in men, and usually starts to develop between the ages of 20 and 40 years old. You may be more likely to develop Kienbock’s disease following a fall that directly impacts your wrist, or from repetitive strain on your wrist, from your job or otherwise.

Diagnosis

See your GP or consultant if you have any of the symptoms and are experiencing pain around the wrist. They will be able to assess your condition and refer you for further tests if necessary, including an x-ray, MRI scan or CT scan. If Kienbock’s disease is caught earlier on, it is easier to treat and manage, however it can be difficult to diagnose initially as it often presents as a wrist sprain.

There are four stages of Kienbock’s disease, and the type of treatment you need is dependent on how advanced your condition is.

Stage 1 – Your lunate bone has lost blood supply
Stage 2 – Due to being unable to receive blood, your bone hardens
Stage 3 – At this stage your bone will have started to collapse
Stage 4 – The collapsed wrist bone will have caused injury to other elements of your wrist, either tendons or bones, due to shards from the collapsed bone

Your clinician will be able to discuss your options with you depending on the above.

Non-surgical treatment

Depending on the severity and the level of pain you are experiencing, your consultant may initially decide to put you on ‘watch and wait’ where they will monitor how your condition progresses with regular re-examination of your wrist. They may also wish to put your wrist in a splint to immobilise it, which may help to restore the blood flow. A physiotherapist can help with exercises and will be able to advise on how best to move without causing further stress to your wrist.

Oral medication such as paracetamol and ibuprofen may help with the pain; however, it is important to note that none of these options will cure the condition. They will however help to slow down the progression and alleviate some pain, which is why prompt diagnosis is always beneficial.

Surgical treatment

There are several surgical treatments that can help with the management of Kienbock’s disease. These are:

Arthroplasty – also known as a total wrist joint replacement, the lunate bone is replaced with a bone substitute.

Revascularisation – this involves a graft of bone from another bone, along with blood vessels, to restore the blood flow to the lunate.
Joint fusion – this is where the lunate bone is fused to other bones.
Joint revelling – involves grafting bone from another bone to alleviate pressure on the lunate. This procedure is performed when the two bones are not the same length.
Proximal row carpectomy – this is the total removal of the lunate bone, however you will be left without full range of motion in your wrist.

Procedures are performed under local or general anaesthetic, and at North West Hand Clinic we will discuss prior to your surgery which option is best for you and most appropriate for the treatment you require.

Recovery

Following surgery, you should be able to go home the next day. A follow up appointment with the surgeon will be made approximately two weeks following your procedure, and if your wrist has been put in a cast you will need to keep it dry. You will also need to try to keep your wrist raised to avoid swelling.

Whatever your hand or wrist condition is, we can help.

Mr Randeep Mohil provides clinics across Lancashire and Cheshire.

Please call us on 01625 466158 or email info@northwesthandsurgeon.co.uk

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Lancashire Clinics

The Beardwood Hospital, Blackburn
Clinic days: Monday evenings (alternate) and Thursday mornings
Website: The Beardwood Hospital
Ramsay Fulwood Hospital, Preston
Clinic days: Monday and Tuesday evenings (alternate)
Website: Ramsay Fulwood Hall

Ramsay Euxton Hall Hospital, Chorley Clinic days: Tuesday evenings (alternate) Website:Ramsay Euxton Hall

Cheshire Clinic, Northwich Clinic days: Friday morning (alternate) Website: The Cheshire Clinic

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Kienböck's disease

What is Kienböck’s disease?

Diagnosis

Non-surgical treatment

Surgical treatment

Recovery

Whatever your hand or wrist condition is, we can help.

Get in touch