The carpal bones are the eight small bones that make up a person's wrist. The lunate bone (one of the carpal bones) is located near the radius, the larger bone in the forearm. The lunate is important for proper wrist movement and rotation. If people suffer from a condition known as Keinbock's disease, it's possible for the lunate bone to die. Patients in the Atlanta, GA area that have Kienbock's disease can count on Dr. Steven Bailey and The Hand Center at Crawford Plastic Surgery for effective treatment.

What Is Kienbock's Disease?

Kienbock's disease is a rare condition in which the blood supply to the lunate bone is cut off. Over time, the interrupted blood supply can cause the bone to die and breakdown, a process known as osteonecrosis or avascular necrosis. As the lunate bone becomes damaged, it causes wrist stiffness and wrist pain, and can lead to arthritis later in life.

Kienbock's disease is most common in men between the ages of 20 and 40. The condition generally affects just one of the wrists rather than both wrists.

Symptoms of Kienbock's Disease

Some of the most common symptoms of Kienbock's disease include:

  • Wrist pain
  • Swelling of the wrist
  • Stiffness of the wrist
  • Loss of grip strength
  • Tenderness in the middle of the wrist

Causes of Kienbock's Disease

The exact cause of Kienbock's disease is unknown, though there are often multiple factors that contribute to the condition. Physical trauma to the wrist can contribute to Kienbock's disease, for instance. In fact, many people with Kienbock's disease first think they've sprained their wrist.

Kienbock's disease may also be the result of irregular bone shape and medical conditions that affect normal blood supply.

Types of Kienbock's Disease

There are different stages of Kienbock's disease depending on the condition of the lunate bone as seen in x-rays.

  • Stage 1: The lunate bone is normal but shows a possible fracture.
  • Stage 2: The lunate bone has begun to harden because of the reduced blood supply, a process known as sclerosis.
  • Stage 3: The lunate bone is dead and begins to breakdown into multiple pieces. The other carpal bones of the wrist may begin to shift from their normal position in response.
  • Stage 4: Damage has spread from the lunate bone to the other adjacent carpal bones. The wrist may become arthritic at this point.

Kienbock's Disease Diagnosis

Diagnosis of Kienbock's disease will involve discussion of the symptoms a patient is experiencing. The patient's medical history will also be considered to help determine the potential causes of the condition.

X-rays of the wrist will help determine what stage of Kienbock's disease the patient suffers from. An MRI may also be taken to measure blood flow in the wrist and assist in diagnosing the condition.

Treatment of Kienbock's Disease

In the early stages of Kienbock's disease, the ideal treatments involve proper monitoring, use of anti-inflammatory drugs, and the use of a splint to reduce stress on the lunate bone and the wrist. These can all relieve the symptoms of Kienbock's disease and prevent progression to further stages.

There are many surgical options to consider for Kienbock's disease, with some more effective than others at various stages.

  • Revascularization: An ideal option for Stage 1 and Stage 2 Kienbock's disease, revascularization can restore the blood supply to the lunate bone. This is done by grafting part of another bone with blood vessels into the lunate bone.
  • Joint Leveling: Joint leveling uses bone grafts to even out the length of the radius and ulna of the forearm. This relieves stress on the lunate bone.
  • Proximal Row Carpectomy: Proximal row carpectomy involves the removal of the lunate bone as well as the two carpal bones on either side of it. This is done in more advanced stages of Kienbock's disease.
  • Bone Fusion: Bone fusion can be performed to join the bones of the wrist together, relieving the stress on the lunate bone. If the wrist has become arthritic, the carpal bones may be fused to the radius.

Recovery after Kienbock's Disease Surgery

Recovery following surgery can vary from patient to patient based on the procedure performed. In general, patients will want to avoid placing stress on the wrist for a few weeks to ensure proper recovery. While full wrist movement may not be restored, surgical treatment will help alleviate pain and preserve some wrist function.

Contact The Hand Center at Crawford Plastic Surgery to learn more about Kienbock's disease and the treatment options available