What is Kienbock’s Disease
Avascular necrosis concerns one bone of the proximal carpal row – the lunate. Its appearing and development may result in discomfort (a slight pain) or in degradation of the functioning (stiffening) of the wrist as a result of destruction of the lunate and destabilisation of the entire carpal bone system and development of extensive degenerative changes.
What causes it?
It is connected with interruptions of blood supply to the bones, but the cause of the disease seems to involve multiple factors. These factors include traumas (e.g. repeated micro-traumas), disturbances of blood supply (arteries) and drainage (veins) to and from the bones. Development of Kienbock’s disease may also be influenced by other diseases
Symptoms
The most frequent symptom is wrist pain situated directly over the lunate bone. The pain increases when the hand is used.
How it is diagnosed?
The diagnosis of the Kienbock’s disease is based on collecting history of the disease and close examination of the hand. An x-ray of the hand and wrist is taken, but in the early stadium of the disease the changes may be invisible. The most reliable examination is the Magnetic Resonance Imaging (MRI) or Computer Tomography scanning.
Treatment
In the early stages of the disease the treatment may involve immobilisation of the wrist in an orthosis/plaster .
In case of more advanced changes, a surgical operation is necessary (revascularization, removal, grafting, shortening of various bones in the forearm or wrist, immobilization of the wrist).
Choice of the type of surgery depends on the stage of development of the disease. The type of chosen treatment should be thoroughly explained to the patient before it is started.
Follow-up after the surgery
The course and time of the advancement of the disease is unpredictable. The applied non-invasive treatment may not bring the expected results.
After the surgery, it may be necessary to immobilise the wrist in an orthosis/plaster for a few weeks.
The arm has to be kept in a sling. Rehabilitation should be started if recommended.