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Kienbocks Disease

Avascular Necrosis of the Lunate

What is Kienbock’s disease?

Destruction of the lunate bone in the wrist due to a lack of blood supply is called Kienbock’s disease. The exact cause is still under study, but many factors like anatomic variation in the wrist and repetitive injury to the wrist have been implicated. The disease is named after Roger Kienbock, a Viennese radiologist, who first described the Xray findings.

What are the signs and symptoms?

A worsening nagging pain in the wrist is the most prominent symptom. A feeling of weakness in the hand can occur. As the disease worsens pain increases and movements decrease. Pressing over the lunate bone can be quite painful.

What is the treatment possible?

Unfortunately, the blood supply to the bone cannot be restored through medications. In some early cases, the blood supply can be improved by grafting bone from elsewhere with its own blood supply [vascularised bone grafting]. However, most patients seek treatment late when the bone destruction has progressed too far. In them removing the first row of bones in the wrist [proximal row carpectomy] gives good function.

What is proximal row carpectomy surgery?

The bones in the wrist are considered to be arranged in two rows, of which the lunate is a part of the first row. When the bone is destroyed beyond repair, removing the entire first row allows the second row to take up this position. Pain improves substantially and movements of the wrist will continue to be possible, although they will be less than normal.

How long is the recovery period after surgery?

Hospital stay of no more than 2-3 days is necessary. Movements can be started by 2nd week in the Physiotherapy Deptt of the hospital. Patients can be back to work within 6-8 weeks.

Keinbocks Disease

Keinbocks Disease

Post operative x-ray after proximal row Carpectomy.

Full supination and pronation and good range of wrist movement three month post operation.

Keinbocks Disease Keinbocks Disease Keinbocks Disease

Keinbocks Disease Keinbocks Disease