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Asian Middle aged Man Suffering From Gout,rheumatoid,chronic Art

Kienböck’s Disease

What Is Kienbock’s Disease?

Kienbock’s disease is caused by a loss of blood supply to the lunate. The lunate is one of eight small bones that make up the “carpal bones” in the wrist.

The carpal area is made up of two rows of bones:

  • Proximal row: The row closer to the forearm
  • Distal row: The row closer to the fingers

The lunate bone lies in the center of the proximal row. It is next to the scaphoid bone, which spans both rows.

What Causes Kienbock’s Disease?

There is likely no single cause for Kienbock’s disease. It may develop due to several contributing factors, including:

  • Blood supply (arteries)
  • Blood drainage (veins)
  • Skeletal variations, such as a shorter ulna or an abnormal lunate bone shape
  • Diseases like gout, sickle cell anemia, and cerebral palsy
  • Trauma, whether from a single event or repeated significant trauma
How Is Kienbock’s Disease Diagnosed?

Patients with Kienbock’s disease usually experience wrist pain and tenderness over the lunate bone. Diagnosis involves:

  • Evaluating medical history
  • Physical examination
  • X-rays

In some cases, further testing may be necessary:

  • MRI: To assess the blood supply to the lunate
  • CT scan or bone scan: May also be used to confirm the diagnosis
How Does Kienbock’s Disease Progress?

The progression of Kienbock’s disease is unpredictable. It may begin in the early stage with pain and swelling but normal X-rays. As the disease progresses:

  • The lunate may develop small fractures and collapse
  • Wrist mechanics change, causing abnormal stress on the joints

Note that not all cases progress to the most severe arthritic stage.

Treatment Options for Kienbock’s Disease

Treatment options depend on the stage and severity of the disease. For early stages, observation and immobilization may be enough. For more advanced stages, surgery may be required to:

  • Reduce the load on the lunate bone by lengthening, shortening, or fusing bones in the forearm or wrist
  • Perform bone grafting or remove the diseased lunate
  • If the disease is advanced, complete wrist fusion may be necessary

Hand therapy can help minimize the disability, although it does not alter the course of the disease. Treatment aims to relieve pain and restore function.

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