Kienböck’s disease is a condition where the lunate bone in the wrist loses its blood supply, leading to bone death (avascular necrosis), collapse, and wrist pain and stiffness. Treating this disease depends on the stage of the condition, the severity of symptoms, and the patient’s age and activity level. The goal of treatment is to relieve pain, preserve wrist function, and prevent further collapse of the lunate bone.
**Non-surgical treatments** are usually the first approach, especially in early or mild cases. These include:
– **Wrist immobilization** using splints or casts for several months (typically 3 to 6 months). This helps reduce stress on the lunate bone, allowing it to heal or slow the progression of damage.
– **Rest, ice, and elevation** to reduce swelling and inflammation in the wrist.
– **Anti-inflammatory medications** such as NSAIDs to control pain and inflammation.
– **Physical therapy** to maintain wrist motion and strengthen surrounding muscles once pain decreases. Therapy can also help improve function and prevent stiffness.
– **Activity modification** to avoid repetitive wrist motions or heavy lifting that could worsen the condition.
If non-surgical methods do not relieve symptoms or if the disease progresses, **surgical options** are considered. Surgery aims to restore blood flow, unload the lunate bone, or remove damaged bone to preserve wrist function. Common surgical treatments include:
– **Revascularization procedures**: These surgeries try to restore blood supply to the lunate bone by grafting blood vessels or bone from other parts of the body. This is more effective in early stages before the bone collapses.
– **Joint leveling procedures**: If the ulna (one of the forearm bones) is longer than the radius, it can put extra pressure on the lunate. Shortening the ulna or lengthening the radius can redistribute forces in the wrist and reduce stress on the lunate.
– **Proximal row carpectomy**: This involves removing the lunate and the two other small bones in the wrist’s proximal row. It relieves pain and maintains some wrist motion but reduces overall wrist strength.
– **Partial wrist fusion**: Fusing some of the wrist bones together stabilizes the wrist and reduces pain. For example, scaphotrapeziotrapezoid (STT) fusion stabilizes the wrist while preserving some motion.
– **Complete wrist fusion**: In severe cases with advanced collapse and arthritis, fusing the entire wrist joint eliminates motion but provides a stable, pain-free wrist.
– **Lunate excision**: Removing the lunate bone may be done if it is severely damaged, often combined with other procedures to maintain wrist stability.
The choice of treatment depends on the disease stage, wrist anatomy, and patient needs. Early-stage disease may respond well to immobilization and revascularization, while advanced stages often require surgery to remove or fuse bones. Rehabilitation after surgery is important to regain motion and strength.
In some cases, doctors may combine treatments, such as immobilization followed by surgery or surgery combined with physical therapy. Newer techniques and individualized approaches continue to improve outcomes for patients with Kienböck’s disease.
Overall, treatment for Kienböck’s disease is tailored to each patient, balancing pain relief, wrist function, and long-term joint health. Early diagnosis and management improve the chances of preserving wrist motion and preventing disability.
