Hand Surgery SR Ship, MS - Orthopaedics, Thesis Work, M.B;B.S
Kienbock’s disease, or avascular necrosis of the lunate, is a condition in which the lunate bone, one of eight small carpal bones in the wrist, loses its blood supply, leading to death of the bone. The lunate is a central bone in the wrist, important for proper movement and support of the joint. The lunate, along with the adjacent bones on either side of it, the scaphoid and triquetrum, make up the proximal carpal row. This row of bones articulates with the 2 forearm bones (the radius and ulna), to form the portion of the wrist that provides the most motion. Damage to the lunate can lead to pain, stiffness, and in late stages, arthritis of the wrist. Kienbock’s disease is most common in men between the ages of 20 and 40 and rarely affects both wrists.
Treatment options depend upon the severity and stage of the disease. In very early stages, the treatment can be as simple as observation or immobilization. For more advanced stages, surgery is usually considered to try to reduce the forces on the lunate bone by lengthening, shortening, or fusing various bones in the forearm or wrist. Surgery can also be aimed at trying to restore blood supply to the lunate (revascularization), using a bone graft with a blood vessel attached to it. This is not an option in more advanced stages if the relationship of the bones has markedly deteriorated; complete wrist fusion may then be the preferred treatment. Hand therapy does not change the course of the disease; however, hand therapy can help to minimize the disability from the problem. Treatment is designed to relieve pain and restore function. Your hand surgeon will advise you of the best treatment options and explain the risks, benefits, and side-effects of various treatments for Kienbock’s disease