What are the other Names for this Condition? (Also known as/Synonyms)

• Avascular Necrosis of the Lunate
• Osteonecrosis of the Lunate

What is Kienböck's Disease? (Definition/Background Information)

• Kienböck's Disease is a rare progressive and debilitating condition that occurs due to the interruption of blood flow to the lunate bone in the wrist. The stoppage of blood flow to the lunate may cause the bone to die
• The interruption of blood flow to any bone in the body can result in the death of bony tissue resulting in a condition known as osteonecrosis, which is a serious bone condition
• Currently, the underlying cause of Kienböck's Disease is unknown, but may occur due to repetitive use of the wrist (during work or participation in sports)
• If an individual is diagnosed with Kienböck's Disease, the treatment predominantly depends on the stage of progression of the condition
• If Kienböck's Disease is detected early and suitable treatment provided, then the affected individuals have a high probability of maintaining adequate function in the wrist with limited pain

Who gets Kienböck's Disease? (Age and Sex Distribution)

• Individuals of all ages, race, ethnic groups, and sexual orientation can develop Kienböck’s Disease
• However, this condition is commonly associated with young adult males and is caused by a repetitive use of one’s wrist
• Kienböck's Disease is also common in middle-aged women

What are the Risk Factors for Kienböck's Disease? (Predisposing Factors)

Common factors that increase the risk for Kienböck's Disease include:

• Individuals, who participate in certain sports activities that require a set of repetitive wrist movements for prolonged periods, such as with baseball or tennis, have an increased risk
• Occupation-related prolonged usage of one’s wrist, which involves a set of repetitive movements (such as in painting or carpentry)

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Kienböck's Disease? (Etiology)

• Currently, the underlying cause of Kienböck's Disease is unknown
• However, researchers believe that in many individuals who develop this condition, it may be associated with any direct or repetitive trauma to the wrist, causing blood flow interruption to the lunate bone. Thus, the condition is also known as Osteonecrosis of the Lunate

What are the Signs and Symptoms of Kienböck's Disease?

The signs and symptoms of Kienböck's Disease may include:

• Noticeable pain and swelling in the wrist
• Stiffness of the wrist and a decreased range of wrist motion

How is Kienböck's Disease Diagnosed?

Common tests a physician may use to diagnosis Kienböck's Disease may include:

• Physical examination with medical history evaluation
• X-ray of the affected region: X-rays use radiation to produce images of the wrist, which can help the physician rule-out other possible causes for wrist discomfort
• Magnetic resonance imaging (MRI): An MRI scan is a more detailed scan that uses radio waves and a magnetic field to produce images that allows a physician to view any damage to the bones and soft tissue, surrounding the affected area
• Computerized tomography (CT): A CT scan takes images of bones and soft tissue, such as the ligaments that connect the joint together. This allows a physician to examine the extent of the injury

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Kienböck's Disease?

Complications associated with Kienböck's Disease may include:

• Complete loss of normal function in the wrist
• Reduced grip strength during the middle stages of Kienböck's Disease

How is Kienböck's Disease Treated?

If an individual is diagnosed with Kienböck's Disease, the treatment mostly depends on the stage of progression (stage I to IV). The level of progression of this condition is explained below:

• Stage I Kienböck's Disease: In this stage, the signs and symptoms exhibit similarities to a sprained wrist
• Stage II Kienböck's Disease: In this stage, persistent pain, swelling, and hardening of the lunate bone in the wrist start to occur, due to interrupted blood flow. The abnormal thickening of the lunate bone results in is a condition known as sclerosis of the lunate bone
• Stage III Kienböck's Disease: In this stage, escalating pain, wrist weakness when gripping an object, and decreased range of motion in the wrist, occur. Also during this stage, the dead lunate bone in the wrist begins to collapse and shatter into several fragments
• Stage IV Kienböck's Disease: In this stage, there is degeneration into the surrounding area of the lunate, which may result in an arthritic wrist

Nonsurgical treatment measures are usually given for lower stages and they include:

• Splint or brace:  A physician may prescribe some type of padded splint or cast to help keep the hand in a stable position, especially while sleeping
• Non-steroidal anti-inflammatory medication: Medications, such as ibuprofen and naproxen, can help decrease the pain and reduce swelling in the wrist

Surgical treatment measures are usually provided for higher stages and they include:

• Revascularization: Occasionally, restoring the blood supply back to the lunate bone is possible. This surgical intervention technique is known as revascularization. This procedure has a high probability for success, when performed during the early stages of the disease, before the degeneration process of the lunate bone sets in
• Joint leveling: Joint leveling is a surgical intervention method recommended, when the two lower arm bones are of different lengths. A bone graft is a surgical procedure that is used to lengthen a selected bone. A bone graft can also shorten a selected bone by removing a bone fragment. This procedure is used to decrease compression of the lunate bone, thus preventing the continued progression of Kienböck's Disease
• Proximal row carpectomy: Proximal row carpectomy is a surgical method that involves the removal of a severely injured lunate bone that has collapsed or shattered into several fragments
• Wrist fusion: If the patient has late-stage Kienböck's Disease resulting in severe degeneration of the lunate bone, then wrist fusion is an option. Wrist fusion involves the release of unwanted pressure on the lunate bone, by fusing two surrounding wrist bones, resulting in one combined bone

How can Kienböck's Disease be Prevented?

• Currently, there are no measures to prevent Kienböck's Disease
• However, it is recommended for individuals (especially athletes) to be consciously aware of the signs and symptoms associated with the condition. This can help in early detection of the condition and prevent it from progressing in severity

What is the Prognosis of Kienböck's Disease? (Outcomes/Resolution)

• It is reported that the majority of individuals who develop Kienböck's Disease, never completely regain a normal function of their wrist
• However, an early detection and treatment gives the patient a high probability of maintaining adequate function in the wrist with limited pain

Additional and Relevant Useful Information for Kienböck's Disease:

This condition was first recognized and named by the radiologist Dr. Robert Kienböck in Vienna, Austria.