Kienbock’s Disease Symptoms, Treatment and Prognosis
Kienbock’s Disease is a seemingly small issue as long as it’s not you who’s affected. Oh your wrist is sore? Yeah people don’t understand the seriousness of this disease and the pain sufferers go through. I recall a colleague once comparing it to his carpal tunnel keyhole surgery after which he was back at work and pain free after a few days! I felt like saying : ‘Dude my bones are mush!’.
I would like to share some reliable information based on the article published by GARD (Genetic and Rare Disease Information Centre) about symptoms and treatment options.
Kienbock’s disease is caused by interruption of blood supply to one of the small bones of the hand near the wrist caled the lunate. If blood supply to a bone stops, the bone can begin to die and deteriorate which is called osteonecrosis.
Misdiagnosis is a huge issue as sufferers often first think they have a sprained wrist and may have experienced trauma to the wrist, which can disrupt the blood flow to the lunate. As the disease progresses, signs and symptoms may include a painful and/or swollen wrist; stiffness; decreased grip strength; tenderness directly over the bone; and pain or difficulty in turning the hand upward. Pushing the palm down on a flat surface can become painful or impossible. The underlying cause of Kienbock’s disease is unknown. Treatment aims to relieve the pressure on the bone and restore blood flow within the bone. Surgery may be recommended.Kienbock’s disease most commonly affects men between the ages of 20 and 40 years, but it affects women as well. Most affected people report or suspect some previous trauma to the wrist. Symptoms can vary depending on the stage of the condition, but usually include pain that is localized to the affected area, decreased motion, swelling, and weakness in the affected hand. Sometimes the
Anxiety and Depression
Many sufferers suffer anxiety and depression due to prolonged periods of pain, being unable to work or be active. Most of those affected used to be or are fit and active and play sports or work out regularly. Dealing with this issue can be very difficult emotionally but it’s good to remember you are not alone and it is possible to recover. For support I highly recommend facebook groups such as Kienbock’s Disease Friends or Kienbock’s Disease as well as Kienbock’s Disease Support Group.
There is no complete cure for Kienbock’s disease, but there are several nonsurgical and surgical options for treatment. Treatment options depend on the stage of the disease (it progresses through four stages of severity), as well as the patient’s age, hand dominance, and ability to function. The goals of treatment are to relieve the pressure on the lunate and to try to restore blood flow within the bone.
Stage I of Kienbock’s disease (with symptoms similar to those of a wrist sprain) is typically treated conservatively, with noninvasive bracing and activity modification. This aims to reduce mechanical stress on the lunate bone. Pain and swelling may be managed with anti-inflammatory medications.
Surgery is typically indicated for the later stages of the disease to reduce mechanical stress on the lunate, stop disease progression, and ideally facilitate restoration of blood flow. The choice of procedure depends mainly on how far the disease has progressed.
Surgical options may include:
- Revascularization – In some cases, particularly in early stages, it may be possible to return the blood supply to the lunate. This involves removing a portion of bone with attached blood vessels from another bone (usually a forearm bone or another hand bone), and inserting it into the lunate.
- Joint leveling – If the two bones of the lower arm (radius and ulna) are not the same length, a joint leveling procedure may be recommended. A bone can be made shorter by removing a section of bone (as in radial osteotomy); a bone can me made longer using bone grafts (as in ulnar lengthening).
- Proximal row carpectomy – In severe cases, the lunate can be removed. In this procedure, the two bones surrounding the lunate are also removed. This procedure can relieve pain while maintaining partial wrist motion.
- Fusion – Nearby wrist bones can be partially or completely fused together to make one, solid bone. If the disease has progressed to severe arthritis of the wrist, fusing all of the bones of the wrist to the radius will relieve pain and and improve hand function. However, all wrist motion would be eliminated.
- Metaphyseal core decompression – In this procedure, the surgeon “scrapes off” part of the radius and ulna without actually removing any osseous tissue.
- Capitate-shortening osteotomy – A central bony wedge of the capitate is removed, followed by fusing the two remaining capitate bone segments.
- Total wrist joint replacement (arthroplasty)
More information about the surgical treatment options for Kienbock’s disease is available from Medscape Reference.
The long-term outlook (prognosis) for people with Kienbock’s disease is hard to predict and the natural history of the disease is not well understood. Kienbock’s disease varies considerably in both severity and rate of progression. Some people with Kienbock’s disease have no symptoms, while others have variable symptoms ranging from mild and intermittent, to severe and debilitating. Furthermore, the severity of the condition as seen on imaging studies does not always correlate with the degree of symptoms a person has.
Each person’s response to treatment depends on the degree of damage to the lunate and surrounding wrist bones. Some people may need more than one procedure if the disease continues to progress. It has been suggested that people who are diagnosed and treated later in life tend not to do as well as those diagnosed and treated earlier. In general, people with Kienbock’s disease should not expect to return to normal wrist function, even after treatment. However, treatment gives the greatest opportunity for long-term preservation of function and pain relief.