Kienbock's disease

Is Kienbock's disease inherited?

There is currently no evidence that Kienbock's disease is inherited. However, the cause of Kienbock's disease is poorly understood. It is possible that unidentified genetic factors contribute to the development of the condition.

Last updated on 05-01-20

What is the long-term outlook for people with Kienbock's disease?

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.

Last updated on 05-01-20

How might Kienbock's disease be treated?

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.

Last updated on 05-01-20

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The RareGuru disease database is regularly updated using data generously provided by GARD, the United States Genetic and Rare Disease Information Center.

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