Kienböck’s Disease: Symptoms & Treatment

Your wrist is a complex joint made up of eight small carpal bones that work in concert with the bones of your forearm to allow for an incredible range of motion. You can flex, extend, and rotate your hand thanks to this intricate structure. At the very center of this complex system is a small, crescent-shaped bone called the lunate. The lunate helps stabilize the wrist and transfer forces between the hand and the forearm. So, what happens when this little (but important) bone is compromised?

If the lunate loses its vital blood supply, the bone tissue can begin to break down and die — a process known as avascular necrosis. This progressive collapse of the lunate bone leads to a condition called Kienböck’s disease. It’s a serious issue that causes significant wrist pain and stiffness and, if left untreated, can lead to debilitating arthritis over time. The good news is that you can manage the condition and stay ahead of further complications with a range of effective conservative therapies and advanced surgical procedures.

What Are the Symptoms of Kienböck’s Disease?

Kienböck’s disease typically develops slowly. In fact, some people don’t even know they have it until it’s in its later stages, while others confuse its symptoms for a simple wrist sprain. As the condition progresses, however, the symptoms become more persistent and distinct.

• Frequent Wrist Pain: The most common symptom of Kienböck’s disease is a dull, aching pain on the back of the wrist, directly over the lunate bone. The pain usually worsens with activity, especially when gripping or turning the wrist.
• Stiffness and Limited Range of Motion: You might find it difficult to bend your wrist backward or make a fist. 
• Swelling and Tenderness: The area over the lunate bone on the top of your wrist may become swollen and tender to the touch.
• Weakened Grip: As the disease progresses and pain increases, you may notice a significant decrease in your ability to grip objects firmly.
• Wrist Clicking: Some people report a painful clicking or clunking sound in the wrist during movement.

Who Is at Risk for Kienböck’s Disease?

While the exact cause of Kienböck’s disease is not always known, researchers have identified several factors that can increase a person’s risk. It is most commonly diagnosed in men between the ages of 20 and 40, but it can affect anyone with:

• Anatomical Variations: Many individuals with Kienböck’s disease have a condition called negative ulnar variance, where the ulna (the forearm bone on the pinky-finger side) is slightly shorter than the radius (the forearm bone on the thumb side). This difference can increase pressure and mechanical stress on the lunate bone.
• Irregular Blood Supply: Some people are simply born with a less robust blood supply to the lunate. The bone may be fed by only a single blood vessel, making it more vulnerable to disruption.
• Trauma: While not always the case, a single significant injury or, more commonly, repetitive micro-trauma to the wrist from certain occupations or sports can disrupt blood flow to the lunate.
• Associated Medical Conditions: In rare cases, medical conditions that affect blood flow, such as lupus, sickle cell anemia, or cerebral palsy, have been linked to Kienböck’s disease.

How Is Kienböck’s Disease Diagnosed?

Diagnosing Kienböck’s disease, especially in its early stages, requires a thorough evaluation by a hand and wrist specialist. The process typically begins with a detailed discussion of your symptoms and medical history, followed by a physical examination of your wrist to pinpoint areas of tenderness and assess your range of motion.

Because the symptoms can mimic other wrist conditions, imaging studies are essential for a definitive diagnosis:

• X-Rays: In the early stages of Kienböck’s, an X-ray may appear completely normal. As the disease progresses, X-rays can reveal increased density of the lunate, followed by signs of collapse, fragmentation, and arthritis.
• Magnetic Resonance Imaging (MRI): An MRI is highly sensitive and can detect the lack of blood flow to the lunate long before changes are visible on an X-ray.
• CT Scan: A CT scan can provide highly detailed, cross-sectional images of the bone, which are useful for evaluating the extent of any fracture or collapse in the lunate.

What Are the Treatment Options for Kienböck’s Disease?

Treatment for Kienböck’s disease is tailored to the individual and depends heavily on the stage of the disease at the time of diagnosis. The primary goals are to relieve pain, restore function, and halt the progression of the bone’s collapse.

Non-Surgical Treatment

In the very early stages, conservative measures may be enough to manage symptoms. These include:

• Immobilization: Resting the wrist in a splint or cast can reduce pressure on the lunate, which may help alleviate pain and potentially allow for blood flow to be restored.
• Anti-Inflammatory Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help reduce pain and swelling.
• Occupational Therapy: OT exercises can improve flexibility and strengthen surrounding muscles, reducing strain on the wrist.

Surgical Treatment

Unfortunately, because Kienböck’s is a progressive disease, most patients will eventually require surgery. The type of surgery recommended depends on the integrity of the lunate bone and the presence of arthritis. Surgical options include:

• Revascularization: In early stages, before the bone has collapsed, a surgeon can perform a procedure to restore blood flow. This involves taking a small piece of bone with its attached blood vessels (a vascularized bone graft) from another part of the wrist or arm and implanting it into the lunate.
• Joint Leveling: If the forearm bones are uneven (negative ulnar variance), a surgeon can perform a procedure to either shorten the radius or lengthen the ulna. This rebalances the forces across the wrist joint and takes pressure off the lunate.
• Proximal Row Carpectomy (PRC): In more advanced stages, when the lunate has collapsed but the rest of the wrist cartilage is healthy, the surgeon may remove the lunate and the two adjacent carpal bones. This creates a new, functional wrist joint with much less pain.
• Fusion (Arthrodesis): If the disease has progressed to severe arthritis, fusing some or all of the wrist bones may be the best option to provide permanent pain relief. While this procedure eliminates motion at the fused joint, it provides stability and strength for gripping.

Take Control of Your Wrist Health Today

Kienbock’s disease is progressive, which means it does not “clear up” or heal on its own. In fact, without treatment, the bone continues to deteriorate, pain becomes more intense, and mobility declines. That’s why it’s so important to seek care as soon as symptoms appear. The earlier treatment begins, the better the chances you have of preserving wrist function and avoiding major surgery.

If you are experiencing persistent wrist pain, stiffness, or weakness, you need an evaluation from a team that specializes in complex conditions of the hand and wrist. The team you need is Philadelphia Hand to Shoulder Center. Our fellowship-trained surgeons have the expertise and advanced diagnostic tools to accurately identify the cause of your pain and develop a personalized treatment plan that is right for you.

Contact our specialists today, and let us help you protect your wrist’s health far into the future.