Kienböcks Disease, also known as Avascular Necrosis Of The Lunate, is a medical condition in which the blood supply to the lunate bone in the wrist joint is disrupted. The condition may also lead to the death of the bone. Lunate is an important bone that provides support and assists in the movement of the joint. Damage to this bone can cause pain, stiffness and if left untreated, may lead to the development of Arthritis.
Causes
- A fall on the wrist/outstretched hand can cause trauma to the joint and cease the blood flow
- The lunate is supplied blood by two arteries but in some people, one of them may be missing. This may reduce the amount of blood that reaches the bone and thus damages it
- Disparity in length of the forearm bones – ulna and radius- may exert excessive pressure on the lunate bone
Symptoms
- Pain in the wrist
- Swelling
- Stiffness in the joint
- Inability to form a firm grip with the hand
- Loss of range of motion
- The middle portion of the wrist is tender when touched
- The hand cannot be moved upwards
Diagnosis
- Analysis of the patient’s medical history, symptoms and injuries to the wrist
- The orthopedic doctor may examine the wrist and the movements that cause discomfort
- X-ray imaging may be done
- MRI scan may help to diagnose the severity of damage to the bone
Treatment
- The disease may be managed through conservative methods of treatment in its initial stages.
- Anti-inflammatory medicines may be prescribed to relieve pain
- Immobilization of the joint using a cast or a splint for 2-3 weeks may relieve pressure from the wrist
- Surgical Revascularization – A piece of bone along with an attached blood vessel is removed from the other hand and attached to the damaged lunate bone.
- External fixator devices may be used to facilitate fusion and re-growth of the lunate
- Joint Leveling – If the wrist bones have difference in length, the doctor may use a bone graft to lengthen one of them or shorten the other by removing a part of it. Leveling may help to reduce pressure on the lunate bone and stop the progression of the disease
- Proximal Row Carpectomy – A surgical procedure in which the lunate is removed along with two adjoining bones. This may be recommended in case the lunate has broken or is severely damaged
- Bone Fusion – The lunate may be fused with one or more bones in the wrist joint for better support