Your bones are not just hardened structures that support the other tissues and organs in your body. They, too, are living tissues that need a regular supply of blood for nourishment and sustainability. Once any blood supply to the bone is ceased, the bone can die. For those suffering from Kienbock’s disease, the blood supply to one of the small bones of the hand near the wrist, also known as the lunate, is interrupted.
While the exact cause of Kienbock’s disease is uncertain, many of those who have it think they are merely experiencing a sprained wrist initially. Perhaps they sustained some sort of trauma to the wrist, such as a fall. A trauma of that kind can disrupt the flow of blood to the wrist.
In most individuals, two vessels supply the blood to the wrist, but some people only have one vessel, thus putting them at an increased risk for developing Kienbock’s disease. As the disease worsens, the patient may notice other symptoms, such as a painful wrist which might be swollen; a limited range of motion or a feeling of stiffness in the wrist; lack of ability to maintain a strong grip in the hand; a tenderness right over the bone, usually on top of the hand near the middle of the wrist; and noticeable pain or trouble with turning the hand upwards.
There are four stages to Kienbock’s disease, and because the disease closely resembles a sprained wrist, it can be a challenge to accurately diagnose. Even X-rays of the wrist can appear normal.
In Stage One, the symptoms are similar to those associated with a sprain of the wrist.
In Stage Two, the lunate, or wrist bone, begins to deteriorate. In this stage, swelling, tenderness, and wrist pain are common.
In Stage Three, the dead bone will begin to collapse and eventually break into smaller pieces. When this occurs, surrounding bones may shift, and the patient may experience increased pain and/or limited motion.
In Stage Four, the surfaces of the adjoining bones are soon affected. A result of this could be arthritis of the wrist.
There is no cure for Kienbock’s disease, but there are some non-surgical and surgical measures that can aid in the treatment of it. The main goal of any treatment for this condition is to relieve any pressure on the wrist and to return the flow of blood to the affected area.
The wrist might be splinted or casted for a few weeks. The patient may take certain anti-inflammatory medications to help with the pain and swelling.
As for surgical options, the type of procedure used is dependent upon how the disease has progressed, the patient’s activity level, the goals of the patient, and the surgeon’s experience with the procedures.
One way to restore the flow of blood via surgical intervention is to take a portion of bone from the inner bone of the lower arm. A metal device may then be used to alleviate the pressure on the wrist and to preserve the spacing between the bones.
Joint leveling, either making the bone longer through the use of a bone graft or shortening a bone by removing a section of it, is a procedure that reduces the forces that compress the wrist, and this seems to stop the progression of the disease.
If the wrist has been severely damaged or broken into pieces, it can be removed. In a procedure known as a proximal row carpectomy, the two bones on either side of the wrist are removed, allowing for partial wrist motion while relieving the pain.
Another option is bone fusion, wherein several small bones of the hand are fused together. If severe arthritis has set in due to the advanced progression of the disease, fusing these bones will help to reduce the pain and maintain function.
Be sure to discuss all possible options with your physician to find out “wrist” one is right for you! (Okay! I could not resist! After all, laughter is the best medicine, right? Hands down! Okay…stop me!)
(Information for this article was found at http://orthoinfo.aaos.org/topic.cfm?topic=a00017)