WHAT IS KIENBÖCK’S DISEASE?
When blood supply to a small bone in the wrist, the lunate, is cut off. If this happens, the bone can die (“osteonecrosis”). Damage to the lunate causes a painful, stiff wrist and can lead to arthritis. Many people think they have a sprained wrist at first, and most have had some trauma to the wrist, such as a fall. Some things may put you more at risk. Some people only have one blood vessel that supplies the lunate, whereas most people have two. Also, if the forearm bones are different lengths, it can put pressure on the lunate during wrist motions.
In the 1st stage, the blood supply has been cut off. In the 2nd stage, the bone hardens. In the 3rd stage, the dead bone begins to break down, and the other wrist bones may shift. In the 4th stage, the bones around the lunate break down, and cause arthritis.
WHAT ARE THE SYMPTOMS?
- A painful and sometimes swollen wrist
- Stiffness with motion and decreased grip strength
- Pain on the top and middle of the wrist
- Pain or difficulty turning the hand up
WHAT MEDICAL TESTS WILL I NEED?
- X-Rays: if the lunate has been damaged for a while, it will show changes on X-ray.
- MRI: if it is early in the disease, an MRI will show changes that may not be seen on X-ray.
HOW IS IT TREATED?
- Conservative: immobilization with a brace or cast, anti-inflammatory medicines, and physical therapy.
- Joint leveling: forearm bones can be made the same length by removing a section of one of the bones.
- Revascularization: removing part of another bone with blood vessels and putting it into the lunate.
- Proximal row carpectomy: removing the lunate along with two bones on either side.
- Fusion: nearby wrist bones can be fused together to reduce the pressure on the lunate.
WHAT DO I NEED TO KNOW ABOUT SURGERY?
- You will be contacted within 2 weeks of your pre-op appointment for pricing and scheduling.
- The surgery will last less than 90 minutes and you will go home the same day.
- Your surgeon will make an incision on the back (dorsum) of the wrist.
- You will have a splint after the surgery for 2 weeks, followed by a cast for at least two more weeks, and then you will wear a wrist brace.
- You can begin lifting 8-12 weeks after surgery.
- Full recovery is expected by 3 months after surgery.