Kienbock's Disease

Dr. Steven Rueda is one of the most sought after doctors for Kienbock’s Disease in Palm Beach. This condition, also known as avascular necrosis of the lunate, leads to gradual degenerative changes in the wrist. Arthritis eventually develops leading to pain and difficulty using the wrist with daily activities.

Kienbock's Disease Symptoms and Diagnosis

The symptoms arising Kienbock’s disease are caused by the gradual deterioration of the lunate bone. In the early phases, patient’s feel pain in the bone itself after its blood supply has been interrupted. With time this causes the bone to loose its architecture and becomes soft and mushy. This loss of support to the wrist causes abnormal forces on all the other joints and precipitates arthritis in the wrist. Chronic Kienbock’s pain therefore arises from the developing arthritis in the wrist.

 

  • Pain in the wrist with bending up or down
  • Pain in the wrist with twisting
  • Swollen and puffy wrist
  • Cracking and popping when moving the wrist
  • Decreased range of motion of the wrist

The diagnosis of Kienbock’s is usually performed by clinical examination, history, and xray imaging. Dr. Rueda frequently uses CT scan and MRI to confirm the diagnosis and stage the disease in preparation for definitive treatment.

WHAT CAUSES Kienbock's Disease?

There is no established cause for Kienbocks disease, however there may be many factors that can possibly contribute. The lunate is one of the wrist bones in contact with the forearm that allows the wrist to bend. In Kienbock’s, the blood supply to this bone is interrupted. It is thought the shape of the wrist bones can be a contributing factor. A short ulna and abnormal lunate shapes have been shown to be more prevalent in those with Kienbock’s. Trauma, medications, and inflammatory diseases have also been associated.

Kienbock's Disease Treatment Options

There are many described treatments for Kienbock’s disease. The type of treatment largely depends on the stage of the disease as well as patient’s goals and expectations.
For very early disease, a trial of casting and immobilization can be enough to treat the condition and lead to symptom resolution. The duration of casting is usually 6 weeks and follow-up xray, MRI, and CT may be obtained to monitor the healing progress.
Surgery is indicated for more advanced stages. The procedures are divided into those that change the architecture of the surrounding bones and those that intend to increase the blood flow to the lunate.
The procedures that change the surrounding bone architecture, attempt to relief pressure off the bone. This is typically accomplished by shortening the radius bone (radial shortening osteotomy), or other wrist bones (capitate shortening). The procedures that increase blood flow try to bring blood supply from other areas of the body into the lunate bone. Some of the procedures to increase blood flow include vascularized bone flaps.
In very advanced disease the entire wrist has developed arthritis. The treatment then becomes the same as for wrist arthritis. This includes surgery for wrist replacement, wrist fusion, or a similar procedure.

Kienbock's Disease Procedure

Incisions for Kienbock’s procedures are highly variable; its best to discuss the independent procedure with Dr. Rueda at the time of your visit so you know the location, length, and details of the operation. In some cases the disease may be treated using stainless steel K-wires placed through the skin with no need to make incisions. In some other cases it may require more complex surgeries including bone shortening or wrist salvage procedures. Those who require wrist salvage procedures require an incision that is usually located in the area shown below:

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RECOVERY AND DOWNTIME

Outpatient procedures. Patients receive a nerve block to minimize pain after surgery. There is tightness, swelling and bruising for 2-3 weeks after surgery. A splint is worn usually for 4-6 weeks depending on the operation.

Return to work depends on the activity and profession. Those whose profession does not require strong manual activity of the hands usually return to work for basic tasks in 2 weeks with a splint or cast in place.

Why Choose Precision Hand Center for your Kienbock's Disease Procedure?

Dr. Rueda, a Hand Fellowship trained surgeon who has 7 years and 2,000 procedures of experience will be your safe and best choice for Kienbocks treatment. Successful results in this procedure requires a surgeon that is experienced and knowledgeable in hand surgery and hand anatomy. Dr. Rueda has published articles in expert peer reviewed journals and his work has been presented in several national conferences. Dr. Rueda’s passion for patient education and custom centered approach will guarantee you feel comfortable every step of the way. Dr. Rueda also believes in treating his patients as if he was treating his own family; you can trust you will enter a trusting and long-term relationship and have some of the best Kienbocks disease treatment Palm Beach can offer.

FREQUENTLY ASKED QUESTIONS (FAQ)

Patients with classic history, symptoms, and exam who have failed casting or who have advanced disease stages are good candidates for surgical procedures.

Results of treatment for this condition vary considerably depending on patient factors, stage of intervention, and type of treatment chosen. The risks and benefits are weighted by the patient and Dr. Rueda to come up with the best option for treatment.