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Kienböck Disease is an acquired bone disorder. Abnormalities of the lunate bone in the wrist develops following an injury or inflammation. Recurrent pain and stiffness occur in conjunction with thickening, swelling and tenderness in soft tissue overlying the lunate bone. The range of motion in the wrist may become limited.
Kienböck Disease is characterized by degenerative changes in the lunate bone of the wrist. Softening, deterioration, fragmentation or compression of the affected bone can occur. These changes may produce pain, swelling, tenderness, thickening and/or stiffness in the overlying tissues of the wrist. The range of motion may become restricted. Many individuals with Kienböck Disease have a shorter ulna than radius (negative ulnar variance). Healing occurs through formation of new bone in some cases.
The exact cause of Kienböck Disease is not known. However, it is believed to be caused by inflammation or injury of the wrist.
Kienböck Disease usually begins during childhood and seems to affect females more often than males.
Symptoms of the following disorders can be similar to those of Kienböck Disease. Comparisons may be useful for a differential diagnosis:
Carpal Tunnel Syndrome is a condition caused by compression of peripheral nerves in the wrist, affecting one or both hands. It is characterized by a sensation of numbness, tingling, burning and/or pain in the hand and wrist. Persons affected by this disorder may be awakened at night with the feeling that the hand has "gone to sleep". Various other diseases may occur in conjunction with this condition. With timely treatment, the prognosis in most cases is favorable. (For more information on this disorder, please choose "Carpal Tunnel" as your search term online.)
Sudeck's Atrophy, also known as post-traumatic osteoporosis, is marked by an acute atrophy of the bones. The wrist and ankle bones are most commonly affected, following a slight injury such as a sprain.
Juvenile Osteoporosis is marked by a porous condition or atrophy of bone tissue beginning before puberty. The exact cause has not been identified. This condition can lead to pain or fractures in many bones of the body including the wrist. Spontaneous remission may occur within several years.
Arthroscopic procedures, CT scan and/or x-ray imaging may be used for diagnosis.
The treatment of Kienböck's Disease may involve surgery of the lunate bone, shortening of the radial bone, lengthening of the ulna or the stiffening of the joints through an operation (arthrodesis). Cutting off the nerve supply of the wrist (wrist denervation) has been used in conjunction with some of the other procedures. Surgical options depend on how far the disease has progressed and the best option will differ for each individual.
If inflammation of the wrist has occurred, drug treatment may be recommended. Other treatment is symptomatic and supportive.
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Current Diagnosis & Treatment in Orthopedics, 1st Ed.: Harry B. Skinner, Editor; Appleton & Lange, 1995. P. 494.
Excision of the Lunate in Kienböck's Disease. Results After Long-Term Followup. H. Kawai et al.; J Bone Joint Surg [Br] (Mar 1988; 70(2)). Pp. 287-92.
Ulna-Minus Variance and Kienböck's Disease. P. A. Nathan et al.; J Hand Surg (Sept 1987; 12(5 pt 1)). Pp. 777-78.
Wrist Denervation Procedures in the Treatment of Kienböck's Disease. D. Buck-Gramcko; Hand Clin (Aug 1993; 9(3)). Pp. 517-20.
Review of Treatment Results in Kienböck's Disease. S. H. Kuschner et al.; Orthop Rev (Jun 1992; 21(6)). Pp. 717-28.
Osteomalacia of the Lunate Bone-Indications for and Limitations of Radial Shortening and Ulnar Lengthening. M. Fishcer et al.; Orthopade (Feb 1993; 22(1)). Pp. 52-56.
Long-Term Results of 9 Cases of Elongation of the Ulna in Treatment of Kienböck's Disease. P. Ducarmois et al.; Ann Chir Main Memb Supter (1997; 16(1)). Pp. 16-24.
Kienböck's Disease: Treatment by Implantation of Vascular Pedicle and Bone Grafting. M. S. Moneim et al.; Iowa Orthop J (1998; 18). Pp. 67-73.
Kienböck Disease and Negative Ulnar Variance. M. Bonzar et al.; J Bone Joint Surg Am (Aug 1998; 80(8)). Pp. 1154-57.
Arthroscopic Evaluation of Radial Osteotomy for Kienböck's Disease. K. Watanabe et al.; J Hand Surg (Sept 1998; 23(5)). Pp. 899-903.
Proximal Row Carpectomy Versus Limited Wrist Arthrodesis for Advanced Kienböck's Disease. R. Nakamura et al.; J Hand Surg (Dec 1998; 23(6)). Pp. 741-45.
FROM THE INTERNET
eMedicine - Kienböck Disease : Article by Brian J Divelbiss, MD
Report last updated: 2007/08/08 00:00:00 GMT+0