Kienbocks's Disease

Kienbocks's disease involves damage to the blood supply of one of the wrist bones called the lunate. It is commonly seen in patients that have an ulnar negative variance, i.e., the ulnar bone is shorter than the radius. It is felt due to the uneven nature of the level of the bones, i.e., the ulnar and the radius at the level of the wrist, there are increased forces across the wrist joint causing damage to the blood supply of the lunate. The clinical presentation is often pain and swelling within the mid portion of the wrist joint. Kienbocks's Disease is graded from mild to severe in which there is significant collapse and degeneration of the lunate bone. In milder cases, often an MRI is needed to make a definitive diagnosis.

In more advanced cases, a common x-ray depicts the pathology. In earlier stages in which there is an ulna negative variance, radial shortening is often affective to prevent further deterioration of the lunate. In more advanced stages, consideration for a vascularized bone graft from the radius along with radial shortening can be given. In later stages, however, these reconstructive procedures are not successful. Treatment at that time could include a proximal row carpectomy in which the first row of bones is actually removed in the wrist and/or wrist fusions.