Does it feel like your wrist is sprained? Is it just getting worse and worse, no matter what you do? A sprain is amenable to rehabilitation. Unfortunately, Kienböck’s Disease will progressively worsen. It is estimated that, among patients undergoing wrist imaging for diagnostic purposes, about 7 in 100,000 are diagnosed with a rare condition known as Kienböck’s Disease.

Kienböck’s Disease is a disorder where the blood supply to one of the small bones of the wrist is interrupted. This bone, the lunate bone, positioned in the centre of the proximal row of carpal bones, sits between the ulna and radius bones of the forearm. Because bone is living tissue, it requires ongoing nourishment which is supplied through the blood. When the blood supply to the lunate bone is limited or stops, the bone begins to die. Known as osteonecrosis, the damaged lunate bone causes symptoms of pain, stiffness, and may result in arthritis.

Pain and Stiffness of the Wrist? It Might Be Kienböck’s Disease.

Kienböck’s Disease is difficult to diagnose. This is because the underlying cause of the disease is still unknown. Moreover, due to the slow progression of the disease, many people do not seek medical attention in the early stages of the disease. Complicating the matter even further, the early presentation of Kienböck’s Disease is similar to other wrist conditions such as a wrist sprain.

Who Does Kienböck’s Disease Effect?

Kienböck’s disease most commonly affects men ranging between 20 and 40 years of age. The condition is usually in one wrist rather than both wrists. There may be a history of injury to the area which has affected the blood supply to the carpal bones. Kienböck’s disease may also be a complication of unique anatomy. Some people have only one blood vessel supplying the lunate rather than two. The bones of the forearm, the ulna, and the radius may be different lengths as well. These are situations that may increase the risk of developing the disease.

Eight Small Bones, One Problematic Lunate

Of the eight small carpal bones of the wrist, the lunate bone plays an important role in supporting the wrist joint and enabling proper movement. This is because of the lunate’s central position in the wrist as well as its placement between the two forearm bones, the radius and ulna. When the blood supply is discontinued to the lunate, it leads to the death of the lunate bone.

Disease Progression, The Four Stages

Kienböck’s disease goes through four stages of progress. Each patient may experience the stages at different rates. Definitive diagnosis is easier in the later stages of Kienböck’s disease. Treatment is determined by the disease’s stage of progression. Reducing pain and preserving function may be easier at earlier stages of Kienböck’s disease.

Stage 1

The presentation of stage 1 of Kienböck’s disease is similar to a wrist sprain. On x-ray, the wrist may have a typical appearance. An MRI scan can detect blood flow. As Kienböck’s disease is due to a lack of blood flow to the lunate bone, an MRI scan helps to make an early diagnosis of the disease.

Stage 2

As Kienböck’s disease progresses to stage 2, the wrist may become swollen, tender, and painful. The lunate bone’s appearance on x-ray is more pronounced because the bone has hardened due to lack of blood flow. At this stage, an MRI scan or CT scan may be recommended to determine a diagnosis.

Stage 3

Stage 3 signifies the death of the lunate bone. The hardened bone begins to deteriorate and collapse. This presents as increased pain, a weak grip, and loss of motion. The bones surrounding the lunate move and shift to occupy the vacant space left by the collapsed lunate bone.

Stage 4

During stage 4 of Kienböck’s disease, the carpal bones adjacent to the collapsed lunate bone begin to decline. The patient experiences pain, loss of function, and arthritis of the wrist.

The Common Signs and Symptoms of Kienböck’s Disease

Each person may experience symptoms of Kienböck’s disease differently. Symptoms may be severe in some cases or rather mild in others.

These are the most common signs and symptoms of Kienböck’s disease.

Wrist Pain

Wrist pain that is ongoing and does not improve over time or with simple measures may be a sign of Kienböck’s disease.

Limited Movement

Difficulty turning the affected hand upwards and other limitations to movement such as pain on movement are symptoms of Kienböck’s disease.

Weakened Grip Strength

Slowly losing grip strength or a progressively weakened grip may be signs of issues with the lunate carpal bone.

Swelling

Swelling over the backside of the wrist may show a problem with the blood supply to the lunate bone.

Tenderness Over the Lunate Bone

Positioned where the ulna and radius bones meet the carpal bones, tenderness over the wrist joint on the back side of the wrist is a symptom of Kienböck’s disease.

Stiffness of the Wrist

Kienböck’s disease may present with stiffness of the wrist joint, typically on movement of just one wrist rather than both wrists.

How the Rare Kienböck’s Disease is Diagnosed

Diagnosis of Kienböck’s disease has several challenges. Firstly, the onset of this disease has a slow progression. Because of this, patients often delay seeking an assessment from a doctor. Secondly, initially, Kienböck’s Disease has a similar presentation to a sprained wrist and may appear normal on examination. Another challenge in diagnosing Kienböck’s disease is that a simple x-ray may not tell the whole story. It requires an MRI scan to determine that the blood supply to the lunate carpal bone has been interrupted.

For these reasons, Kienböck’s disease is often diagnosed incidentally in patients who are undergoing examination of the wrist due to other concerns.

When to See a Doctor About Slowly Progressing Wrist Pain

It is important to see your doctor about your wrist pain promptly. A doctor can provide evaluation, diagnosis, and treatment plan. A doctor may also provide recommendations and referrals to a higher level of care such as a Specialist Hand Surgeon.

A Specialist Hand Surgeon can advise treatment options, including the risks and benefits to optimise the outcome of Kienböck’s disease.

The Combination of Causes for Kienböck’s Disease

Kienböck’s disease is not fully understood. Its cause is related to abnormal or lacking blood flow to the lunate bone which causes the lunate bone to die. The blood flow may be interrupted due to an incident of trauma or injury to the wrist. Blood flow can also be limited or cease due to unique skeletal anatomy. Such as the case of irregularly shaped lunate or carpal bones. Blood flow may be limited with forearm bones of uneven lengths. Certain medical conditions can affect blood supply which may contribute to factors of Kienböck’s disease.

Treatment Aims to Relieve Pain and Restore Function

Currently, there is not a definitive cure for Kienböck’s disease. The course of treatment is determined by the stage of the disease. There are nonsurgical and surgical options available in treating Kienböck’s disease. Each treatment option is oriented to provide improved function, reduction in pain, and minimise disease progression.

In the early stages of Kienböck’s disease, using nonsurgical and surgical methods to restore blood flow to the lunate bone could be considered. This may include activity changes or immobilisation to reduce pressure on the lunate bone. Anti-inflammatory medications or the application of ice may reduce swelling to improve blood flow. Surgery to revascularize the lunate bone to return the blood supply to the lunate is also a potential treatment. Surgery to manipulate adjacent bones that put pressure on the lunate or interrupt its blood supply may be considered as well.

In the later stages of Kienböck’s disease, once the lunate bone is no longer viable, surgical options are available to relieve pain and maintain hand and wrist function. The lunate bone may be removed, sometimes along with adjacent carpal bones. A bone fusion may be performed to reduce pain and restore wrist function.

Kienböck’s Disease Wrap-Up

Early Diagnosis and Treatment to Preserve Function and Relieve Pain

Kienböck’s disease is a condition of loss of blood supply to the lunate bone of the wrist. Each patient with Kienböck’s disease may experience different rates of severity and progression of the disease. Slow onset, a variation in causes, and presentation make Kienböck’s disease challenging to diagnose. MRI is one way to determine a loss of blood flow to the lunate bone.

Although Kienböck’s disease is not completely understood and there is no cure, there is treatment available through all stages of the disease. The treatment options provide long-term pain relief and preserved function of the hand and wrist.

Are you slowly losing power and motion in your wrist? Speak to the caring hand specialists at CHARMS at +65 6733 9093. Or book an appointment for a consultation, diagnosis, and treatment plan options.