Kienbock Disease

What is Kienbock Disease

Kienbock disease is a condition in which the cells die in of one of the bones of the hand and wrist (lunate bone) because of a lack of blood supply. This condition causes gradually increasing wrist pain that can develop over months or years.

What are the causes?

No single cause of Kienbock disease has been proven. Suspected causes of this condition include:

  • Falling on an outstretched hand and injuring or fracturing the lunate bone.
  • Repeated small injuries (trauma) to the wrist.
  • Having a forearm bone that has an unusual shape, which puts increased pressure on the lunate bone.
  • Some medical conditions that affect blood supply.

What increases the risk?

This condition is more likely to develop in:

  • People who have a longer than normal bone of the forearm that is on the same side as the thumb (radius).
  • People who have a shorter than normal bone of the forearm that is located on the same side as the little finger (ulna).
  • People who have a lunate bone that has an unusual shape.
  • People who do activities that result in repeated trauma to the wrist.
  • People who are 20–40 years old.
  • People who have lupus, sickle cell anemia, or cerebral palsy.

What are the signs or symptoms?

Symptoms of this condition include:

  • Wrist pain with or without wrist movement.
  • Pain when the injured area is touched.
  • Wrist stiffness.
  • Wrist swelling.
  • Difficulty with wrist movement due to pain or stiffness.

How is this diagnosed?

This condition is diagnosed with a medical history and physical exam. Your health care provider will ask for details about your injury and your symptoms. Imaging studies are often used to confirm the diagnosis and may include:

  • X-ray.
  • MRI.
  • CT scan or bone scan.

Diagnosis can also include staging, which assesses the severity and extent of the condition. This condition can progress through four stages.

  • Stage 1. In this stage, the lunate bone has already lost its blood supply and you may have wrist pain. X-rays of the lunate bone may appear normal.
  • Stage 2. In this stage, wrist pain continues. Imaging studies may show hardening of the lunate bone.
  • Stage 3. In this stage, you may have wrist pain and stiffness. Imaging studies may show lunate bone collapse.
  • Stage 4. In this stage, you will likely have wrist pain, stiffness, and swelling. Imaging studies may show a collapsed lunate bone and damage to the surrounding wrist bones.

This condition does not always progress through all four stages.

How is this treated?

Treatment may start with restricting wrist motion to prevent further damage. This is often done by wearing a splint or brace. Treatment may include the use of icing and medicines to reduce pain and swelling. In less severe cases, treatment may also include working with a physical therapist to decrease pain and improve wrist function.

In severe cases, surgery may be needed to change the structure of the wrist joint.

Follow these instructions at home:

If you have a splint or brace:

  • Wear it as told by your health care provider. Remove it only as told by your health care provider.
  • Loosen the splint or brace if your fingers become numb and tingle, or if they turn cold and blue.
  • Keep the splint or brace clean and dry.

Managing pain, stiffness, and swelling

  • If directed, apply ice to the injured area.
    • Put ice in a plastic bag.
    • Place a towel between your skin and the bag.
    • Leave the ice on for 20 minutes, 2–3 times per day.
  • Move your fingers often to avoid stiffness and to lessen swelling.
  • Raise (elevate) the injured area above the level of your heart while you are sitting or lying down.

General instructions

  • Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Keep all follow-up visits as directed by your health care provider. This is important.
  • Do not drive or operate heavy machinery while taking prescription pain medicine.

Contact a health care provider if:

  • Your pain, tenderness, or swelling gets worse even if you have had treatment.
  • You have numbness, tingling, or discoloration in your wrist, hand, or fingers on the injured side.
  • You have new symptoms.
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