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Kienböck Disease

by David R. Steinberg, MD

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

The cause of this relatively unusual disease is unknown. It occurs most commonly in the dominant hand of men aged 20 to 45 years, usually in workers doing heavy manual labor.

Symptoms 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 person has no recollection of injury. The disorder occurs in both hands in 10% of cases. Diagnosis is possible at an early stage by magnetic resonance imaging (MRI) or computed tomography (CT) and, if necessary, is later confirmed by x-ray.

Surgery is done to relieve pressure on the lunate bone, for example, by lengthening or shortening bones that connect to the lunate bone. Alternative treatments attempt to reestablish the blood supply to the bone (such as a bone 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.