Kienböck's disease

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Kienböck's disease
Diagram of the human wrist, showing the location of the lunate bone
Synonyms	Lunatomalacia
Pronounce	N/A
Specialty	Orthopedic surgery
Symptoms	Wrist pain, stiffness, swelling
Complications	Osteoarthritis, loss of wrist function
Onset	Typically between ages 20 and 40
Duration	Chronic
Types	N/A
Causes	Disruption of blood supply to the lunate bone
Risks	Trauma, repetitive stress, anatomical variations
Diagnosis	X-ray, MRI
Differential diagnosis	Scaphoid fracture, Wrist sprain, Rheumatoid arthritis
Prevention	N/A
Treatment	Immobilization, Physical therapy, Surgery
Medication	NSAIDs
Prognosis	Variable, depends on stage and treatment
Frequency	Rare
Deaths	N/A

Kienböck's disease is a condition that affects the lunate bone in the wrist. It is characterized by the progressive collapse of the lunate bone due to a disruption in its blood supply, leading to avascular necrosis. This condition can result in chronic pain and limited wrist function.

Pathophysiology

Kienböck's disease occurs when the blood supply to the lunate bone is compromised. The exact cause of this disruption is not well understood, but it is believed to be related to repetitive trauma, anatomical variations, or other underlying conditions that affect blood flow. The lack of blood supply leads to the death of bone tissue, causing the lunate to collapse and deteriorate over time.

Stages

Kienböck's disease is typically classified into four stages based on radiographic findings:

• Stage I: Early changes with possible fracture lines but no collapse.
• Stage II: Sclerosis and fragmentation of the lunate without collapse.
• Stage III: Collapse of the lunate with or without carpal instability.
• Stage IV: Advanced collapse with secondary osteoarthritis of the wrist.

Symptoms

The primary symptoms of Kienböck's disease include:

• Chronic wrist pain, particularly over the lunate bone.
• Swelling and tenderness in the wrist.
• Decreased range of motion and grip strength.
• Stiffness and difficulty performing daily activities.

Diagnosis

Diagnosis of Kienböck's disease typically involves a combination of clinical evaluation and imaging studies. X-rays, MRI, and CT scans are commonly used to assess the condition of the lunate bone and the extent of the disease.

Treatment

Treatment options for Kienböck's disease vary depending on the stage of the disease and the severity of symptoms. They may include:

• Non-surgical treatments: Immobilization with a cast or splint, nonsteroidal anti-inflammatory drugs (NSAIDs), and physical therapy.
• Surgical treatments: Procedures such as revascularization, joint leveling, lunate excision, or wrist fusion may be considered in more advanced cases.

Prognosis

The prognosis for Kienböck's disease varies. Early diagnosis and treatment can help manage symptoms and slow the progression of the disease. However, in advanced stages, the condition may lead to significant wrist dysfunction and chronic pain.

See also

• Avascular necrosis
• Lunate bone
• Wrist
• Orthopedic surgery
• Physical therapy

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