Kienbock's Disease
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Introduction

Kienbock's disease is a condition in which one of the small bones of the wrist loses its blood supply and dies, causing pain and stiffness with wrist motion. In the late stages of the disease, the bone collapses, shifting the position of other bones in the wrist. This shifting eventually leads to degenerative changes and osteoarthritis in the joint. While the exact cause of this uncommon disease isn't known, a number of treatment options are available.

This guide will help you understand

  • how Kienbock's disease develops
  • how doctors diagnose the condition
  • what treatment options are available

Anatomy

How does the wrist joint work?

The anatomy of the wrist joint is extremely complex, probably the most complex of all the joints in the body. The wrist is actually a collection of many joints and bones. These joints and bones let us use our hands in lots of different ways. The wrist must be extremely mobile to give our hands a full range of motion. At the same time, the wrist must provide the strength for heavy gripping.

The wrist is made of eight separate small bones, called the carpal bones. The lunate is one of these bones.

It is the bone that is affected in patients with Kienbock's disease.

The carpal bones connect the two bones of the forearm, the radius and the ulna, to the bones of the hand. The metacarpal bones are the long bones that lie underneath the palm. The metacarpals attach to the phalanges, which are the bones in the fingers and thumb.

Causes

Why do I have this condition?

Doctors have not determined exactly what causes Kienbock's disease. A number of factors seem to be involved. Usually the patient has injured the wrist. The injury may be a single incident, such as a sprain, or a repetitive trauma. But the injury alone does not seem to cause the disease.

The way that blood vessels supply the lunate is thought to play a role in Kienbock's disease. Some bones in the body simply have fewer blood vessels that bring in blood. The lunate is one of those bones. A bone with a limited blood supply may be more at risk of developing the disease after an injury. The reduced blood supply might be the result of a previous injury to the blood vessels.

Other bones around the lunate may play a role in the disease, too. The length of the ulna, the bone of the forearm on the opposite side of the thumb, may be a factor. When the ulna is shorter than the radius, the lunate bone absorbs more force when the wrist is used for heavy gripping activities. Over time, this extra force may make it more likely for a person to develop Kienbock's disease. The extra forces make a person more likely to injure the lunate or the blood vessels around it as a result.

Kienbock's disease is also sometimes found in people with other medical conditions that are known to damage small blood vessels of the body. Whatever the cause, the lunate bone develops a condition called osteonecrosis. In osteonecrosis, the bone dies, usually because it's not getting enough blood.

Symptoms

What does Kienbock's disease feel like?

The primary symptoms of Kienbock's disease are pain in the wrist and limited wrist motion. Pain may vary from slight discomfort to constant pain. In the early stages there may be pain only during or after heavy activity using the wrist. The pain usually gets slowly worse over many years. The wrist may swell. The area over the back of the wrist near the lunate bone may feel tender. You may not be able to move your wrist as much as normal or grip objects as well.

Patients often have the condition for months or years before seeking treatment. Typically, the patient will report an injury to the wrist in the past or have a history of repetitive heavy use of the wrist. Kienbock's disease most frequently affects men 20 to 40 years old. It rarely affects both wrists.

Diagnosis

How do doctors identify the problem?

Your doctor will begin by taking a detailed history of the problem and examining the wrist.

X-rays and possibly a magnetic resonance imaging (MRI) scan will be ordered. The X-rays are useful to determine how far the disease has advanced. This helps your doctor plan treatment. The MRI machine uses magnetic waves instead of radiation to take a series of pictures that look like slices of the wrist. The MRI scan is most useful if your doctor is not sure whether the lunate bone has lost its blood supply. The MRI is extremely accurate at showing whether a bone has a blood supply or not. Changes in the lunate bone will usually appear on one of these tests. No other tests are usually required.

　

Treatment

Acupuncture is to improve blood and qi circulation which is the dominant change in Kienbock's disease. According to Chinese medicine, pain is caused by blood/qi stagnation along the meridians. Stimulation of the acupoints around the affected area will cause the increase of blood supply and activate the repair process.