All about Kienbock Disease

What is Kienbock Disease?

Kienbock’s disease is a rare disorder that disrupts the supply of blood to the lunate. The lunate is one of eight tiny carpal bones in your wrist which is located at the middle of the base of your wrist and quite vital for wrist movement. In an early stage, this disorder causes pain and as it progresses, the bone tissue might die leading to more pain, wrist immobility, and arthritis. Kienbock’s disease generally affects only one wrist. Surgery and other treatments can relieve pain and maintain wrist function. Everyone with Kienböck’s disease does not experience symptoms, and due to this, the disease is discovered whilst a doctor is examining your wrist for a different reason.

What are the Types of Kienböck’s Disease?

There are no types of this disorder but there are stages which your doctor might tell you. Stage 1 is the least severe and stage 4 is the most severe. MRI scans and CT scans are helpful to detect the stage by ruling out fractures and detecting blood flow.

The stages include:

Stage 1: In stage 1, the pain is similar to a wrist sprain. The cause might not be clear, but it’s likely because the blood supply to your lunate has slowed down or stopped.

Stage 2: In stage 2, your lunate begins to harden due to the lack of blood flow. The procedure of hardening is known as sclerosis, which means your bone is dying.

Stage 3: In stage 3, your hardened lunate begins to break which may cause the other bones in your wrist to move around. You will start feeling more, struggle to hold things with as much power and your range of motion will become limited.

Stage 4: In stage 4, the outsides of the bones adjacent to your lunate will become weak and your wrist may become arthritic.

What are the Symptoms of Kienböck’s Disease?

It’s not necessary that everyone with Kienböck’s disease experiences symptoms. The common symptoms include:

• Wrist pain is the same as a sprained wrist. A sprained wrist might be a dull pain that comes and goes or a sharp pain that’s more persistent.
• Pain in your lunate bone.
• Swelling in the wrist.
• Stiffness in the wrist.
• Weakness in the wrist.
• Creaking, crackling or grating sounds while moving your wrist.
• Not able to move your wrist the way you used to.
• Reduced strength when you try to grip something.

What are the Causes of Kienböck’s Disease?

Various factors can result in a decrease in blood supply to the lunate bone. Some causes of Kienbock’s disease may include:

Trauma: Trauma to the wrist because of accidents, such as a slip or a fall, may cause injury or swelling.

Uneven bones in your forearm: There are two bones in your forearm known as the ulna and the radius. If your ulna is shorter than your radius bone, the pressure on your wrist might increase which raises your risk of getting Kienbock’s disease.

Irregular lunate bone: If the shape of your lunate bone is a little bit infrequent, you might get Kienbock’s disease.

Underlying medical conditions: Kienbock’s disease might be linked to medical conditions affecting the blood supply. Medical conditions including lupus, sickle cell anemia, and cerebral palsy may also lead to Kienbock’s disease.

What are the Risk Factors of Kienböck’s Disease?

Though Kienböck’s disease can happen at any age but adults are at a higher risk. The disease generally begins in early adulthood generally people designated male at birth between the ages 20 to 40.

You are at an increased risk for Kienböck’s disease if you have any medical condition that affects your blood like sickle cell anemia or lupus, along with people with certain conditions including cerebral palsy.

What are the Complications of Kienböck’s Disease?

Some common complications that might occur due to Kienböck’s disease include:

Scapholunate dissociation: It is also called rotary subluxation of the scaphoid which is an unusual orientation of the scaphoid, relative to the lunate, and causes serious injury to the scapholunate interosseous ligament and other stabilizing ligaments.

Sickle cell anemia: It is an inherited red blood cell disorder where there are not enough healthy red blood cells in the blood to carry oxygen throughout the body.

Cerebral palsy: It is a group of conditions affecting movement and or posture that occurs because of the damage that occurs to the immature brain.

How Kienböck’s Disease is Diagnosed?

To diagnose this condition, you have to consult with your doctor and report your symptoms. You should be specific about the type and area of your pain, and how long you have been experiencing it. Your doctor might prescribe some tests, including:

• X-ray
• MRI.
• CT scan.
• Bone scan.

What are the Treatment Options Available for Kienböck’s Disease?

Kienbock’s disease treatment options vary based on the stage of the disorder including:

Medication: In the starting stages, symptoms such as swelling and pain can be managed by using anti-inflammatory medicines, including ibuprofen or aspirin.

Immobilisation: Your doctor might immobilise your wrist using a plaster attached for nearly 2 to 3 weeks to relieve the pressure on the lunate bone.

Surgery: If the disease progresses further with the symptoms persisting, you might have to go through surgery.

The surgical options available to treat Kienbock’s disease include:

Revascularization: It’s a surgery performed to treat the early stages of Kienbock’s disease, which consists of transporting blood cells from other parts of your wrist directly to your lunate. It helps to restore the blood supply to the bone.

Joint levelling: Your surgeon will carry it out to level out the uneven bones in your forearm which shorten or lengthen your radius or ulna so that they won’t put pressure on your wrist.

Lunate excision: In this procedure the lunate bone is fully removed or the pieces of bone from your wrist are removed. The surgeon might attach an artificial bone to replace your lunate.

Intercarpal fusion: It’s performed in the late stages of the disorder, to attach the lunate to a neighbouring wrist bone. It is usually done with revascularization to restore blood flow to the lunate bone.

Proximal row carpectomy: In the last stage of Kienböck’s disease, you might develop wrist arthritis due to the broken lunate bone. Proximal row carpectomy involves the removal of four of the eight bones from your wrist to create room for your wrist to move.

After surgery for Kienböck’s disease, you have to wear a splint for around 3 to 4 months and you need to visit the surgeon for a follow-up to make sure that the bone is healing. You will have to begin physical therapy for a few months once your wrist heals, to strength and movement of the wrist strength and movement. When the pain fades away, you can resume your routine life and daily activities.

Living with Kienbock’s disease

Kienböck’s is a rare disease affecting a bone in your wrist. Kienböck disease is a progressive disease, meaning you might not have experienced symptoms at all or even if you experience symptoms, they might be mild at first. But gradually your symptoms will become more pronounced and might affect your ability to carry out your daily activities but there are effective treatments available to treat this condition. This disease is easier to treat in its beginning, after which you can lead a normal and healthy life.

Whom to Consult?

If you experience symptoms such as pain, swelling, stiffness, or weakness in your wrist then you should inform your healthcare provider about them as they may be symptoms of Kienböck’s disease. Your doctor will take a physical exam and some tests to confirm your diagnosis rule out other conditions and start treatment accordingly.