Introduction
Kienbock’s disease is a progressive disorder affecting the lunate bone in the wrist. This condition arises from a disruption in the blood supply to the lunate, leading to its decay and eventual death. As a result, the wrist's structure and function can be severely impacted. Treatment options include immobilization, anti-inflammatory medications, pain relief, and surgery.
Anatomy
The lunate is one of the eight small bones that comprise the wrist, specifically part of the proximal carpal row. It plays a crucial role in the radiocarpal and midcarpal joints. The midcarpal joint allows for upward movement of the hand towards the thumb, while the radiocarpal joint enables downward movement towards the little finger side.
Causes
The precise cause of Kienbock’s disease remains unclear. It occurs when blood flow to the lunate bone is disrupted. Adequate blood supply is vital for bone health; without it, the lunate can decay and die, impacting wrist function and structure. Factors that may disrupt blood flow include trauma, such as falls, and excessive use of the dominant hand. Individuals with a single artery supplying the lunate instead of two are also at an increased risk.
Kienbock’s disease is more prevalent in men than in women and typically develops in individuals aged 20 to 40, often affecting the dominant hand.
Symptoms
The primary symptom of Kienbock’s disease is wrist pain, which may manifest as stiffness, tenderness, and swelling. Patients might notice reduced wrist mobility and decreased grip strength, making it challenging to hold objects. As the condition progresses, symptoms can worsen, potentially leading to arthritis and significant loss of wrist function.
Diagnosis
A healthcare provider can diagnose Kienbock’s disease through a physical examination and diagnostic imaging. Patients should communicate their symptoms and any recent wrist injuries. Initial X-rays may appear normal, while MRI or CT scans can provide detailed images to assess the condition.
Kienbock’s disease is classified into four stages:
- Stage 1: Normal X-ray findings with symptoms resembling a wrist sprain.
- Stage 2: Hardening of the lunate is visible on X-ray, with increasing pain and swelling.
- Stage 3: The lunate bone collapses and fragments, causing increased symptoms and limited movement.
- Stage 4: Nearby bone surfaces are affected, leading to arthritis in the wrist.
Treatment
Treatment strategies vary based on the stage of Kienbock’s disease. Early stages may benefit from splints or casts to alleviate pressure on the lunate and restore blood flow. Medications can also help manage pain and reduce inflammation. More advanced stages may require surgical intervention.
Surgery
Surgical options for Kienbock’s disease depend on the disease stage, activity level, and anticipated outcomes. Possible procedures include:
- Revascularization Surgery: Aims to restore blood supply to the lunate bone.
- Joint Leveling Procedures: Involve lengthening or shortening the forearm bones to relieve pressure on the lunate.
- Proximal Row Carpectomy: Involves removing the severely damaged lunate and adjacent bones to alleviate pain while allowing partial wrist movement.
- Fusion: Connects several wrist bones to reduce pressure on the lunate, though it does not enhance wrist mobility. It can help manage pain, especially in patients with arthritis.
Recovery
Kienbock’s disease is a chronic condition that tends to worsen over time. While no cure exists, both surgical and nonsurgical treatments can alleviate symptoms, preserve mobility, and maintain wrist function.
