Dr. Daniel Penello — a leader in wrist, hand, and small bone surgery — presented on Kienböcks Disease at the Florida Orthopaedic Society Annual Meeting on June 21, 2019. Discussing the causes, diagnosis, and treatment of Kienböcks, Dr. Penello is helping patients find mobility after life-altering wrist trauma.
About Kienböcks Disease
Kienböck’s disease, also known as Avascular Necrosis of the Lunate, is a rare, debilitating condition that causes chronic pain in the wrist. Kienböck's affects the lunate bone, which is one of eight small bones in the wrist. Typically caused by injury, the lunate bone loses its blood supply, leading to the death of the bone. Kienböck’s has been found mostly in men ages from 20-40, though women have also been diagnosed with the disease.
About the Lunate Bone
The lunate is a central bone in the wrist that is crucial for proper movement and function of the joint. Closely working with the two forearm bones (radius and ulna), it helps the wrist to move. The earliest signs of Kienböck’s disease are central wrist pain and swelling. Symptoms are aggravated by activity and improved with rest and anti-inflammatory medication. Left untreated, the dead lunate bone eventually fractures and collapses, leading to severe pain and advanced wrist arthritis.
There is no single cause of Kienböck’s disease. It often arises due to trauma, like falls, or repetitive microtrauma, such as operating machinery, in susceptible individuals. There are certain variations in wrist bone anatomy and blood flow patterns which make some people more susceptible to this condition than others.
The diagnosis of Kienböck’s disease can often be made by reviewing your history, performing a physical examination, and taking x-rays. In the early stages of this disease, the x-rays may be normal. The most reliable test to assess the blood supply of the lunate is Magnetic Resonance Imaging (MRI) which can reliably identify Kienböck’s disease in its earliest stage. CT scans can be used to look for a lunate fracture and evaluate the extent of arthritis.
This is a slow-progressing disease, and patients often have the condition for months or even years before they seek treatment. Treatment options depend upon the severity and stage of the disease. Delay in the diagnosis and treatment of the condition can lead to chronic pain, progressive wrist arthritis, and a significant loss of wrist and hand function.
Our understanding of the condition continues to evolve, as do the available treatment options. Therefore, to successfully restore blood flow to the lunate bone and achieve the best outcome possible, it is critically important to be evaluated by an experienced hand surgeon specialized in the diagnosis and treatment of this uncommon but potentially life-altering condition.
Dr. Daniel Penello is Double Board Certified and Fellowship trained in the management of complex hand and upper extremity conditions. As a leader in this field, Dr. Penello is keenly aware of the latest advances in the treatment of conditions such as Kienbock’s Disease and teaches these exciting and innovative techniques to surgeons across the country.