Sometimes your wrist just hurts, right? It's like a sprain. Most people think it's a minor sprain that will go away in a few days. But sometimes there's a more serious cause behind this pain. Kienböck's disease is a rare but important condition to be aware of. This name may be new to you, but it's important to be aware of it.
Simply put, what is Kienböck's disease?
Okay, let's explain this very simply. Your wrist is made up of small bones, that is, 8 bones joined together. We call these `(Carpal bones)` . Among these eight bones, there is a small bone that is shaped like a crescent moon, right in the middle. This is what doctors call the `(Lunate)` bone. This `(Lunate)` bone helps a lot in bending and rotating our wrist well.
Kienböck's disease is a condition in which the blood supply to the lunate bone gradually decreases and eventually stops. Just like a tree dies without water, this bone gradually dies without blood. In medicine, this is called osteonecrosis . This does not happen suddenly, but gradually worsens over time. Sometimes, this can even lead to conditions like arthritis in the wrist.
Who is more likely to develop this? What are the causes?
Although this disease can occur at any age, it is usually most common in men between the ages of 20 and 40. However, this does not mean that women cannot develop it.
It is not yet 100% certain what exactly causes the blood flow to the lunate bone to decrease. However, there are several factors that are thought to contribute to this:
- Problems with the blood vessels that supply blood to the bone: Some people are born with abnormalities in the way the blood vessels that supply blood to the ``Lunate`` bone are positioned. In such cases, there is a greater chance of reduced blood supply. Experts believe that this is the main cause.
- Trauma to the wrist: You may have fallen, been in a car accident, or suffered a severe injury to your wrist while playing sports. This can happen when the lunate bone is damaged and blood flow is cut off, causing this condition.
- Variation in the length of the bones in the hand: There are two main bones in the lower part of our hand, the radius and the ulna . In some people, these two bones are not the same length. One is slightly shorter than the other. When this happens, abnormal pressure is placed on the lunate bone when the wrist moves. Over time, this pressure can damage the bone and impair blood flow.
- Other medical conditions: People with blood-related diseases such as ``Sickle cell anemia'' and ``Lupus'', and those with certain neurological diseases such as ``Cerebral palsy'' are also at risk of developing Kienböck's disease.
What are the symptoms of this disease?
Most of the time, there are no major symptoms in the early stages of this disease. Some people may not have any symptoms at all. But there are some common symptoms that are seen. Let's see what they are.
| Symptom | How does that feel? |
|---|---|
| Wrist pain | It's like the pain of a sprained wrist. It can be a mild pain that comes and goes sometimes, or it can be a constant, sharp pain. |
| Swelling and stiffness | My wrist looks swollen. When I wake up in the morning, it feels stiff and difficult to bend. |
| Difficulty holding (weak grip) | My hands feel weak when I do things like open a water bottle cap or turn a doorknob. My wrists hurt when I lift something heavy. |
| Restriction of movement | You can't bend your wrist up and down or side to side as easily as you used to. |
| Crepitation | When you move your wrist, it makes a 'cracking' sound, as if the bones are grinding from within. |
| Pain in a specific place | I feel pain when I press my finger on the top of my wrist, right in the middle (where the lunate bone is). |
The most important thing is, when you experience pain like this, don't ignore it, thinking, "It's just a sprain." Especially if the pain doesn't subside after a week or two, you should definitely see a doctor.
How does a doctor diagnose this disease?
When you go to the doctor, he will ask you about the pain, how long it has been there, and when it gets worse. Then he will examine your wrist. He will need to do several tests to confirm the diagnosis.
- X-ray examination: The first thing to do is an X-ray. However, in the early stages of the disease, the X-ray may not show much difference.
- MRI Scan: This is the best way to diagnose this disease. An MRI scan can detect at the earliest stage whether the ``Lunate`` bone is bleeding or not, and whether the bone has started to die.
- CT scan: A CT scan can help to clearly see if the bone is broken or fragmented.
- Bone Scan: This can look at the function of the bones in the body.
The four stages of Kienböck's disease
After these tests, the doctor will tell you what stage your disease is in. There are 4 main stages.
| Stage | What happens at this stage? |
|---|---|
| Stage 1 | This is the first time. The pain feels like a sprained wrist. There is no difference in the X-ray. But if you look at it with an MRI, you can see that the blood supply to the `(Lunate)` bone is reduced. |
| Stage 2 | Due to the lack of blood, the bone begins to harden like a rock. This is called ``sclerosis'' . On an X-ray, the bone appears whiter than the rest. The pain increases a little. |
| Stage 3 | The hardened bone is now breaking and starting to break into pieces. This can cause the other bones in the wrist to move slightly from where they used to be. The pain increases, the strength in the hand decreases, and it becomes difficult to bend the wrist. |
| Stage 4 | This is the worst case. The lunate bone is almost completely broken and shattered. Not only that, but the other bones around it also start to wear away. The wrist joint itself is damaged, and arthritis occurs. |
It may take some people a few months to go from stage 1 to 4. For others, it may take years.
What are the treatments for this?
Although there is no single cure for this disease, current treatments can help reduce pain, improve wrist function, and stop the disease from getting worse. Treatment depends on many factors, including the stage of your disease, your age, and your occupation.
Treatments without surgery
These are usually done early in the disease.
- Wrist immobilization: The wrist is immobilized in a cast for several months. This rest can sometimes help the bone regain blood flow.
- Painkillers: Your doctor may recommend anti-inflammatory medications like ibuprofen to reduce pain and swelling. But remember, these medications are not suitable for people with asthma, stomach ulcers, high blood pressure, kidney or heart disease. So , never take these medications without consulting a doctor.
- Occupational therapy: An occupational therapist will teach you how to perform daily tasks in a way that reduces wrist pain.
Treatment through surgery
If the disease is severe, or if other treatments do not help, the doctor may recommend surgery. The type of surgery performed will vary depending on the stage of the disease.
| Name of the surgery | Simply put, this is what happens... |
|---|---|
| Joint Leveling | If the length of the two bones in the forearm, ``Radius'' and ``Ulna'', is different, a surgery is performed to equalize their lengths. A small piece of bone is grafted onto the short bone to lengthen it, or a small piece is cut from the long bone to shorten it. This reduces the pressure on the ``Lunate'' bone. |
| Revascularization | This involves restoring blood supply to the lunate bone. A small piece of bone with a blood vessel is taken from another part of the body (e.g., the thigh) and transplanted into the dying lunate bone. This can only be done in the first two stages of the disease. |
| Fusion | When the disease is severe, several bones in the wrist are placed together to reduce pain. Sometimes, if the bones of the entire wrist are placed together, the wrist cannot be bent, but the hand can be rotated. |
| Proximal Row Carpectomy (PRC) | If the lunate bone is completely broken, the bone and several nearby bones are removed. This reduces pain, but limits some wrist movement. |
| Implant Arthroplasty | In this, the damaged ``Lunate`` bone is removed and replaced with an artificial bone (``prosthetic``). |
When should you definitely see a doctor?
The sooner this disease is detected, the better the treatment and results will be. So, don't wait until you experience the symptoms below and see a doctor.
- If you have difficulty moving your wrist, hand, or fingers.
- If there is unusual redness around the wrist.
- If the swelling is getting worse.
- If there is unbearable pain .
Your doctor will refer you to a specialist in this regard, namely an orthopaedist .
Take-Home Message
- Kienböck's disease is a rare condition in which the blood supply to the small bone in your wrist called the lunate is cut off, causing it to gradually die.
- The first symptom may simply be a pain that feels like a sprained wrist. So if you have persistent pain like this, don't ignore it.
- This disease gradually worsens over time. If left untreated, the pain can increase and the hand can become completely immobile.
- Your results will largely depend on how quickly you detect the disease and begin treatment.
- Talk to your doctor to decide which treatment method is best for you.
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