What is and how to treat Kienbock disease

Kienbock's disease is a condition where one of the small bones that make up the wrist, known as the lunar bone, does not receive the necessary amount of blood and therefore begins to deteriorate, causing constant pain in the wrist and difficulty moving or closing the hand, for example.

This alteration can appear at any age, however, it is more common between the ages of 20 and 40 and rarely affects both fists at the same time.

Although there is no definitive cure for Kienbock's disease, some forms of treatment such as surgery or the use of medicines can be used to relieve pressure on the bone and relieve symptoms.

How to relieve symptoms

The treatment for Kienbock's disease is done only to relieve pain and difficulty in moving the wrist, since the increase in circulation to the bone is very difficult to achieve. For this, there are several forms of treatment that must be evaluated by an orthopedist according to the degree of development of the disease and the intensity of the symptoms

Some of the most used forms of treatment include:

1. Immobilization of the wrist

Many cases of Kienbock's disease can improve only with immobilization of the wrist, as this way the bone is less overloaded, allowing inflammation and pressure at the site to decrease.

To immobilize the wrist, the doctor usually applies plaster on the hand, which must be kept for at least 2 or 3 weeks.

2. Anti-inflammatory remedies

The use of anti-inflammatory drugs, such as Aspirin or Ibuprofen, is one of the first ways of treating this problem and usually works by relieving the swelling of the tissues around the semilunar bone, reducing pressure and relieving pain.

3. Physiotherapy and stretching exercises

Performing some stretching exercises for the wrist can help to relieve the pressure of the muscles on the bones, relieving pain and allowing greater freedom of movement.

Generally, these exercises can be done during physiotherapy sessions, but they can also be trained at home after guidance from a physical therapist. Here are some wrist stretches that can help relieve pain.

4. Surgery

Surgical treatment is usually reserved for more advanced cases of Kienbock's disease, when symptoms do not improve with the treatment methods indicated above.

The type of surgery varies depending on the person and the specific problem, including:

  • Repositioning of the bones of the wrist joint: when one of the bones of the arm is slightly shorter, the doctor may insert a small bone graft or remove a piece of the longer bone, in order to balance the joint and reduce pressure on the bone semi-lunar, relieving symptoms;
  • Removal of the semilunar bone: when the semilunar bone is very deteriorated, the orthopedist may choose to completely remove the bone. However, in these cases it is also necessary to remove the two bones that are on the side, which eliminates the pain, but can reduce the range of motion of the wrist;
  • Fusion of the wrist bones: in some cases, a treatment option consists of sticking the wrist bones together, in order to form a single bone that receives blood circulation from the other bones that were separated, relieving all symptoms.

In addition, surgery can also be used at an early stage of the disease to try to direct blood circulation to the semilunar bone. In this technique the doctor removes a piece of another bone that is receiving blood and sticks it to the semilunar bone, allowing it to also be irrigated by blood. However, this technique is not possible in all cases and may not show satisfactory postoperative results.

How to confirm the diagnosis

The pain caused by Kienbock's disease is often confused with carpal tunnel syndrome and, therefore, it is advisable to consult an orthopedist to confirm the diagnosis and initiate appropriate treatment.

To make the diagnosis, the doctor may order some diagnostic tests such as X-ray of the wrist and MRI. These tests also facilitate the assessment of the degree of evolution of the problem:

  • Stage 1: in this phase the X-ray is usually normal, but the MRI indicates a lack of circulation to the bone;
  • Stage 2: the semilunar bone begins to become harder due to the lack of circulation and, therefore, appears whiter in color than the other wrist bones, on X-ray;
  • Stage 3: at this stage the bone begins to break and, therefore, exams can show the various pieces at the bone site and change in the position of the surrounding bones;
  • Stage 4: it is the most advanced phase where the pieces of semi-lunar bones cause deterioration of the surrounding bones, causing arthritis in the wrist.

As the disease progresses, the pain in the wrist becomes more intense, and the movements become more difficult. Thus, knowing which stage allows the doctor to choose the most appropriate treatment option.