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Kienböck Disease

(Kienböck's Disease)

By David R. Steinberg, MD, Associate Professor, Department of Orthopaedic Surgery, and Director, Hand and Upper Extremity Fellowship, Perelman School of Medicine at the University of Pennsylvania

Kienböck disease is the death of bone tissue due to an impaired blood supply (osteonecrosis) affecting the lunate bone in the hand.

The lunate bone is one of the carpals in the wrist.

Bones in the Wrist

The carpals are the bones in the wrist. They are located between the bones of the forearm and those of the hand.

Kienböck disease is relatively rare. It is not known why the blood supply to the lunate bone becomes impaired. People typically do not remember being injured. It occurs most commonly in the dominant hand of men aged 20 to 45 years, usually in workers doing heavy manual labor.

Symptoms

Symptoms of Kienböck disease typically start with wrist pain that begins gradually in the area of the lunate bone, which is in the middle of the wrist at the base. Eventually, swelling occurs on top of the wrist, which may become stiff. The disorder occurs in both hands in 10% of people.

Diagnosis

  • Imaging tests

Diagnosis of Kienböck disease is possible at an early stage by magnetic resonance imaging (MRI) or computed tomography (CT) and, if necessary, is later confirmed by x-rays.

Treatment

  • Surgery

Surgery is done to relieve pressure on the lunate bone, for example, by lengthening or shortening bones that connect to the lunate bone. Alternative surgical treatments are done in an attempt to reestablish the blood supply to the lunate bone (such as a bone graft or blood vessel graft). If the lunate bone has collapsed, the wrist bones may be removed or surgically fused together (called arthrodesis) as a last resort to relieve pain.

Attempts to treat this disease with methods other than surgery have not been successful, but wearing a wrist splint may relieve pain in very mild cases.

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