...less medical jargon in a 'Quick Glance' format!
In Kienbocks Disease, the blood supply to one of the small bones of the hand near the wrist is interrupted. Bone is living tissue that requires a regular supply of blood for nourishment. If the blood supply to a bone stops, the bone can die. This is known as osteonecrosis.
In most people, two vessels supply blood to the lunate, but in some people there is only one source. This puts them at greater risk for developing the disease. As the disease progresses, other signs and symptoms are noted, including:
A painful and sometimes swollen wrist
Limited range of motion in the affected wrist
Decreased grip strength in the hand
Tenderness directly over the bone
Pain or difficulty in turning the hand upward
The cause of kienbocks disease is not known. Many people with Kienbocks disease think they have a sprained wrist at first. They may have experienced some form of trauma to the wrist, such as a fall. This type of trauma can disrupt the blood flow to the lunate.
Although there is no cure, there are several nonsurgical and surgical options for treating Kienbocks disease. The goals of treatment are to relieve the pressure on the lunate and to try to restore blood flow within the bone.
. . . Nonsurgical Treatment
The wrist may be splinted or casted for two to three weeks. Anti-inflammatory medications, such as aspirin or ibuprofen, will help relieve any pain and reduce swelling. If the pain continues, your physician may refer you to an orthopaedic or hand surgeon for further evaluation.
. . . Surgical Options
There are several surgical options for treating the more-advanced stages. The choice of procedure will depend on several factors, including disease progression, activity level, personal goals, and the surgeon's experience with the procedures.
In some cases, it may be possible to return the blood supply to the bone. This procedure takes portion of bone from the inner bone of the lower arm. A metal device may be used to relieve pressure on the lunate and preserve the spacing between bones.
If the bones of the lower arm are uneven in length, a joint leveling procedure may be recommended. Bones can be made longer using bone grafts or shortened by removing a section of the bone. This leveling procedure reduces the forces that bear down on the lunate and seems to halt progression of the disease.
If the lunate is severely collapsed or fragmented into pieces, it can be removed. In this procedure, the two bones on either side of the lunate are also removed. This procedure, called a proximal row carpectomy, will relieve pain while maintaining partial wrist motion.
Another procedure that eases pressure on the bone is fusion. In this procedure, several of the small bones of the hand are fused together. If the disease has progressed to severe arthritis of the wrist, fusing the bones will reduce pain and help maintain function. The range of wrist motion, however, will be limited.