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Kienböck's disease is avascular necrosis of the lunate bone.
Kienböck's disease occurs most commonly in the dominant hand of men aged 20 to 45, usually in workers doing heavy manual labor. Overall, Kienböck's disease is relatively rare. Its cause is unknown. The lunate can eventually collapse and cause fixed rotation of the scaphoid and subsequent degeneration of the carpal joints.
Symptoms and Signs
Symptoms generally start with insidious onset of wrist pain, localized to the region of the lunate carpal bone; patients have no recollection of trauma. Kienböck's disease is bilateral in 10% of cases. There is localized tenderness in the lunate bone.
Diagnosis
MRI and CT are the most sensitive; plain x-rays show abnormalities later, usually beginning with a sclerotic lunate, then later cystic changes, fragmentation, and collapse.
Treatment
Treatment is aimed at relieving pressure on the lunate by surgically shortening the radius or lengthening the ulna. Alternative treatments attempt to revascularize the lunate (eg, implanting a blood vessel or bone graft on a vascular pedicle). Salvage procedures (eg, proximal row carpectomy or intercarpal fusions) may help preserve some wrist function if the carpal joints have degenerated. Total wrist arthrodesis can be done as a last resort to relieve pain. Nonsurgical treatments are not effective.
Last full review/revision March 2008 by David R. Steinberg, MD
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