Kienbock’s disease is necrosis of the lunate bone in the wrist due to poor or restricted blood supply. It is more common in adult males although has been known in young gymnasts. Symptoms consist of gradually worsening wrist pain.
Symptoms
Symptoms of Kienbocks disease include:
- Gradual onset wrist pain which becomes progressively worse.
- Swelling over the lunate bone on the back of the wrist.
- Pressing in over the lunate will be painful and tender.
- Limited or restricted wrist mobility.
- Diagnosis by MRI scan is controversial in the early stages of the disease as it may be confused with overuse/overload of the lunate bone.
What causes Kienbock’s disease?
Overuse or repetitive microtrauma is thought to be the most common cause. It is most common in adult males, although it has been known to occur in a 14-year-old female gymnast.
Treatment
Whether surgery is needed or not will depend on how far your disease has progressed and the level of function you have in the wrist.
Conservative treatment (without surgery) involving long term immobilisation in a cast has been shown to be ineffective in preventing the progression of the disease once it has been diagnosed. Therefore, it is essential that an accurate diagnosis has been made and it has not been confused with an overuse ‘stress reaction’ of the lunate bone.
If your injury is a simple stress reaction then active rest by avoiding high impact loading of your wrist is thought to be effective, as long as it is diagnosed within 3 months of symptoms occurring.
Overall, the evidence for effective treatment and Kienbock’s disease is controversial.
References & further reading
- Herzberg G, Mercier S, Charbonnier JP et al. Kienböck’s disease in a 14-year-old gymnast: a case report. J Hand Surg Am 2006;31(2):264–8.
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