Kienböck’s Disease
Bones of the hand and wrist. H=hamate; C=capitate; TZ=trapezoid; TP=trapezium; TQ=triquetrum; L=lunate; S=scaphoid; U=ulna; R=radius. Numbers denote fifth, fourth, third, and second metacarpals.
Reproduced with permission from Lichtman DM, Joshi A: Acute Injuries of the Distal Radioulnar Complex and Triangular Fibrocartilage Complex. Instr Course Lect 2003;52:175-183.
Bone is living tissue that requires a regular supply of blood for nourishment. If the blood supply to a bone stops, the bone can die. This is known as osteonecrosis. In Kienböck’s disease, the blood supply to one of the small bones of the hand near the wrist (the lunate) is interrupted.
The cause of Kienböck’s disease is not known. Many people with Kienböck’s disease think they have a sprained wrist at first. They may have experienced some form of trauma to the wrist, such as a fall. This type of trauma can disrupt the blood flow to the lunate.
In most people, two vessels supply blood to the lunate, but in some people there is only one source. This puts them at greater risk for developing the disease. As the disease progresses, other signs and symptoms are noted, including:
- A painful and sometimes swollen wrist
- Limited range of motion in the affected wrist (stiffness)
- Decreased grip strength in the hand
- Tenderness directly over the bone (on the top of the hand at about the middle of the wrist)
- Pain or difficulty in turning the hand upward
Kienböck’s disease progresses through four stages. In its early stages, Kienböck’s disease may be difficult to diagnose because the symptoms are so similar to those of a sprained wrist. Even X-rays of the wrist may appear normal.
Stage 1: Symptoms are similar to those of a wrist sprain.
X-rays may be normal or suggest a possible fracture. Magnetic reso
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