Avascular Necrosis of Lunate (Keinbocks Disease)

Kienböck’s disease, which causes pain, stiffness and weakness in your wrist, can make everyday activities difficult. In the late stages, you may get arthritis. This can happen quickly — within several months — or it could take years. Surgical and nonsurgical treatments can help reduce pain and recover or maintain motion of your wrist.

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.

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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 males ages 20 to 40.

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

Symptoms and Causes

How do you get Kienböck’s disease?

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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.

Diagnosis and Tests

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:

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.

Management and Treatment

What kind of healthcare provider treats Kienböck’s disease?

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.
Bone scan.

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 nonsurgical 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.

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