Kienböck’s Disease

What is Kienböck’s disease?

Kienböck’s disease is the breakdown of a small crescent-shaped bone in your wrist (the lunate). The breakdown happens slowly, getting worse with time. Kienböck’s disease can sometimes lead to arthritis of your wrist.

Not everyone with Kienböck’s disease experiences symptoms, so sometimes the disease is discovered while a healthcare provider is examining your wrist for a different reason.

Which bone does Kienböck’s disease affect?

Your lunate is one of eight carpal bones in your wrist. It’s located near the center. Together with two other bones that make up your forearm (the radius and the ulna), the lunate helps your wrist move.

Who is at risk for Kienböck’s disease?

Adults are at a higher risk, but Kienböck’s disease can happen at any age. The disease usually starts in early adulthood, most commonly in people designated male at birth (DMAB) ages 20 to 40.

You’re at a higher risk for Kienböck’s disease if you have any disorders that affect your blood such as sickle cell anemia or lupus, but there is also a higher risk among individuals with certain conditions such as cerebral palsy.

How do you get Kienböck’s disease?

Although the exact cause of Kienböck’s disease is unknown, several factors might contribute to the breakdown of your lunate bone, including:

• Less blood flow to your lunate. Experts think this is the most likely factor. Your bone can die if it doesn’t receive nourishing blood. The death of a bone is called osteonecrosis.
• Trauma to your lunate. It might have been damaged in a car accident, for example.
• Irregular forearm bones. If your ulna and radius bones in your forearm aren’t the same length, that can cause problems with your wrist.
• Irregular lunate shape. You might’ve been born with a lunate that’s the wrong shape.

What are the symptoms of Kienböck’s disease?

Not everyone with Kienböck’s disease experiences symptoms. Commonly reported symptoms include:

• Wrist pain that's similar to a sprained wrist. A sprained wrist can be a dull ache that comes and goes or a sharp pain that’s more consistent.
• Pain directly over your lunate bone (about the center of your wrist).
• Swelling of your wrist.
• Stiffness of your wrist.
• Weakness of your wrist.
• Creaking, crackling or grating sounds when you move your wrist (crepitation).
• An inability to move your wrist like you used to (a decreased range of motion).
• Less strength when you go to grip something.

Can Kienböck’s disease cause arthritis?

Yes, late-stage Kienböck’s disease can make your wrist arthritic. Arthritis of the carpal bones of your wrist causes pain, swelling, stiffness and wrist and hand weakness. There are both nonsurgical and surgical treatments for it.

How is Kienböck’s disease diagnosed?

You’ll meet with your healthcare provider and report your symptoms. Be as specific as you can about the type and location of your pain, and how long you’ve been experiencing it. Your healthcare provider might order tests, including:

• X-ray
• MRI.
• CT scan.
• Bone scan.

What are the stages of Kienböck’s disease?

Your healthcare provider might tell you the stage of your Kienböck’s disease. Stage 1 is the least severe and stage 4 is the most severe. MRI scans and CT scans help determine the stage by ruling out fractures and detecting blood flow.

• Stage 1: In stage 1, you might feel pain similar to a wrist sprain. Although the cause might be unclear, it’s likely because the blood supply to your lunate has slowed down or stopped.
• Stage 2: In stage 2, your lunate starts to harden because of the lack of blood flow. The process of hardening is called sclerosis, and it means your bone is dying.
• Stage 3: In stage 3, your hardened lunate will start to break. This might cause the other bones in your wrist to move around. You’ll feel more pain, struggle to grip things with as much power and your range of motion will be limited.
• Stage 4: In stage 4, the outsides of the bones near your lunate will also weaken. Your wrist might become arthritic.

It might be several months or several years between stage 1 and stage 4.

What kind of healthcare provider treats Kienböck’s disease?

Your primary healthcare provider might refer you to one or more specialists who can help with your Kienböck’s disease. Specialists include:

• A hand surgeon who specializes in procedures of the wrist, as well as the hand.
• An orthopaedist who specializes in the diagnosis, prevention and treatment of bone, joint, ligament, muscle and tendon disorders.
• An occupational therapist who can help you manage your pain and improve your wrist movement.

What’s the treatment for Kienböck’s disease?

Although there’s no single cure for Kienböck’s disease, treatment can help:

• Restore blood flow to your lunate.
• Lessen your pain.
• Improve your wrist movement.
• Stop Kienböck’s disease from getting worse.

What are the nonsurgical treatments for Kienböck’s disease?

There are both nonsurgical and surgical treatments for Kienböck’s disease. Examples of nonsurgical treatments include:

• Keeping your wrist from moving by putting it in a cast for up to several months. If your wrist is rested, the blood flow might resume.
• Occupational therapy. Your occupational therapist can show you how to use your wrist in ways that reduce pain and slow down the disease.
• Taking medications such as cortisone injections and over-the-counter (OTC) anti-inflammatory medications, including ibuprofen (Advil®, Motrin®) and naproxen (Aleve®).

Check with your healthcare provider regarding the best medications for you. Note that ibuprofen and naproxen are not suitable for people with some health conditions, including:

• Asthma.
• Stomach ulcers.
• High blood pressure.
• Kidney problems.
• Heart problems.

What are the surgical treatments for Kienböck’s disease?

There are five types of surgeries recommended for Kienböck’s disease. The right one for you depends on the stage of your disease and your healthcare provider’s recommendations. Possible surgeries include:

• Joint leveling. Joint leveling is necessary when the two bones that make up your forearm (your radius and ulna) are different lengths. The different lengths put extra force on the lunate bone, squeezing it. Your surgeon will remove a tiny bit of bone to shorten the radius or ulna, or use bone grafts to lengthen it.
• Revascularization. This procedure restores or increases the amount of blood flowing to your lunate. Your surgeon will take a small section of bone from another part of your body and put it into your lunate. Pins will hold your bones together while they heal, and a metal device outside of your wrist will keep everything in place. Revascularization can only be done during stages 1 or 2.
• Fusion. You may have a partial fusion or a complete fusion. This permanent procedure is where your surgeon fuses together (welds together, sticks together) some or all of the bones in your wrist. If you have a complete fusion, you won’t be able to move your wrist, but you’ll still be capable of rotating your forearm.
• Implant arthroplasty. For this procedure, your surgeon replaces your lunate with a prosthetic.
• Proximal row carpectomy (PRC). If your lunate is broken, it and some other carpal bones in your wrist might be removed.

What can I do to prevent or reduce my risk of Kienböck’s disease?

Although there’s nothing you can do to prevent Kienböck’s disease, there are effective treatments.

If you were born with two vessels supplying blood to your lunate, you have a lower chance of getting Kienböck’s disease than someone with only one.

What’s the outlook for people with Kienböck’s disease?

Sometimes Kienböck’s disease can lead to arthritis in your wrist. This is an unfortunate complication of the disease. Talk to your healthcare provider about the chances of that and figure out a treatment plan together.

Can Kienböck’s disease go away on its own?

Kienböck’s disease isn't a disease that will simply go away. If you don’t get treatment, your wrist will hurt more and more, and you’ll slowly lose your ability to use it. It’s important to see your healthcare provider for treatment as soon as possible.

Can Kienböck’s disease get worse?

Yes, you can expect your symptoms to get worse over time. As time goes by, the pain will increase and you’ll be able to use your wrist less and less, keeping you from going about your normal activities. This is why it’s important for you to see your healthcare provider quickly.

How fast does Kienböck’s disease progress?

The time between stage 1 and stage 4 of Kienböck’s disease can be several months to several years.

Can I live a normal life with Kienböck’s disease?

The pain, stiffness and weakness of Kienböck’s disease is burdensome. It can keep you from going about your activities pain-free, and may even stop you from doing them at all. The best way to maintain or recover your best quality of life with Kienböck’s disease is to get treatment as soon as possible.

When should I contact my healthcare provider?

Don’t wait until the following symptoms are severe before you contact your healthcare provider. The sooner you’re diagnosed, the sooner you can get treatment. Contact your healthcare provider if you:

• Can’t move your hand, your wrist or your fingers.
• See unusual redness around your wrist.
• See extra swelling.
• Feel pain that you can’t bear.

What questions should I ask my healthcare provider about Kienböck’s disease?

You might want to attend your appointment with your healthcare provider with a list of questions, like:

• Will I have arthritis in my wrist?
• What stage of Kienböck’s disease am I in?
• When should I return to be reevaluated?
• What exercises might help?
• Should I see an occupational therapist?
• Do I need surgery?

When should I go to the emergency department?

Call emergency services or go to the emergency department right away if you experience any of the following problems:

• Trouble breathing/shortness of breath, or if you stopped breathing for any reason.
• Severe chest pain or pressure to your chest. Any pain that is so severe that you can’t stand it.
• Injury to your head, neck or spine.
• Loss of consciousness (if you pass out/faint).
• Sudden weakness, especially if you can’t speak or move.
• Dizziness that doesn’t stop.
• A seizure that lasted 3 to 5 minutes.
• Poisoning or an overdose.
• Severe allergic reaction.
• Coughing or throwing up blood.
• Heavy bleeding.
• High fever that doesn’t get better with medicine.
• Severe burn, electric shock or lightning strike.
• Stroke symptoms like slurred speech, numbness, weakness, loss of balance and/or vision problems.

How rare is Kienböck’s disease?

Kienböck’s is a rare disease. It’s usually found when you have a scan of your wrist for reasons other than checking for this disease. Out of about 100,000 people whose wrists are scanned, around seven will have Kienböck’s.

A note from Cleveland Clinic

Kienböck’s is a rare disease that affects a bone in your wrist. It’s a progressive disease, which means you may not have symptoms or your symptoms might be mild at first. But your symptoms will become more pronounced and may limit your ability to perform your activities of daily living. The good news is that there are effective treatments available. Kienböck’s disease is easier to treat in its early stages, so don’t hesitate to mention symptoms like pain, swelling, stiffness or weakness in your wrist to your healthcare provider.