Sussex Hand CONDITION Surgery Kienbocks Disease CONDITION What is This is a relatively rare condition in which the blood supply of the lunate bone in the wrist is reduced. The can result in part, or all, of the Kienbocks bone very gradually dying and collapsing over time. Eventually this collapse can lead to Disease? arthritis in the joints nearby. Normal Wrist Xray How is the diagnosis of Once the lunate has started to Kienbocks Disease made? collapse a radial shortening might still be considered. An alternative Thumb It is important to get a clear metacarpal would be to take out the lunate history from the patient and and make the scaphoid join onto examine the wrist very carefully. The scaphoid the capitate (fusion) to stop the The capitate Sometimes the problem can be bone bone rest of the wrist collapsing into the seen on a simple Xray. A magnetic hole left where the lunate was. resonance imaging (MRI) scan The lunate Once arthritis has set in around picks up very early changes in the bone the lunate the options are more lunate, even when the Xrays are Distal ulna limited but include a proximal normal, and is the most sensitive row carpectomy (taking out the Distal radius test for this condition. three bones in the first row of the wrist), a total wrist fusion (joining What treatment is available all the wrist bones together) or a for Kienbocks Disease? wrist replacement. Wrist Xray showing early Kienbocks Disease There is no cure for Kienbocks Disease. Treatment depends on What is the long term Lunate, how advanced the condition is outcome for patients when it comes to light. As the whiter than with Kienbocks Disease? condition is relatively rare there is surrounding little evidence to guide doctors as Few long term studies of this rare bones to what is really the best option condition are available for us to at each stage. Painkillers, splints know what happens to patients and steroid injections can all help with this disease if no surgery is undertaken. That makes it very End of ulna relieve symptoms to some extent difficult to know whether or not (shorter than at all stages. surgery designed to halt the radius) End of distal Surgery is often also considered. progression of the disease has radius Early on, when the lunate bone is really made any difference to what still a good shape, two options are would have happened anyway. commonly recommended: Small studies do suggest that the 1. A vascularised bone graft - a options mentioned above for the Who gets Kienbocks What symptoms does wedge of bone from the end of early stages of the disease may Disease? Kienbocks Disease give? the radius rotated into the lunate relieve pain in a good percentage with its attached blood vessel still This condition is most frequent in The symptoms usually gradually of patients, at least in the short to in place. This aims to directly medium term. young adults. There is sometimes increase over time. There is a import a new blood supply and a history of an injury to the wrist. variable amount of pain in the wrist, bone into the lunate. Surgery to relieve pain in the late It seems to be more frequent in usually in the middle at the back. It stages of the disease is effective patients whose ulna is rather short can feel as if the pain goes up and 2. Shortening the radius bone - but usually at the expense of lost compared to the radius. This is down the forearm and into the cutting a section out of the end wrist motion. Your hand surgeon called ‘negative ulnar variance’ hand. Over time the wrist gets less of the radius to make it shorter can advise you further. (see picture above).’ flexible than the other side (stiff) and holding the remaining bone and the grip weakens. Sometimes together with a plate and screws. there is swelling in the wrist. This aims to even up the load on the lunate. www.sussexhandsurgery.co.uk These notes are intended as a guide and some of the © Sussex Hand Surgery details may vary depending on your individual January 2018 circumstance and at the discretion of your surgeon..