Kienbocks disease orthopedic surgery, algonquin, il. I was diagnosed august 2017 with keinsbock disease stage 3b fri feb 16th having radial shortening osteotomy. Progressive pain, without a clear history of acute trauma, is the primary presenting complaint. In stage 2 the bone hardens due to lack of blood supply and appears abnormally dense on xray. Its at the middle of the base of your wrist and important for wrist movement. I had never even heard of this disease until a few months ago.
Symptoms tend to reflect the severity of the disease, ranging from mild discomfort to debilitating pain. Staging and treatments physical therapy in lincoln and ashland for wrist. All statistical analyses were performed using the statistical software package spss. My experience with kienbock s disease peachlovehappiness. Kienbocks disease progresses through four stages of severity. Also, patients frequently complain of associated wrist swelling, decreased wrist motion and loss of grip strength. Kienbock s disease lunatomalacia is a condition that usually develops as a result of repetitive injury to the wrist, which leads to osteonecrosis, damage, and death of the lunate bone due to the loss of its blood supply. Contact michigan surgery specialists for more information. By stage iii or iv, most believe that kienbock s disease is irreversible, and treatment with palliative fusion procedures predominates. The stahl classification of kienbock disease, modified by lichtman, is the most commonly used staging system and is useful in the treatment of kienbock disease avascular necrosis of the lunate. Your doctor will ask about your medical history, your lifestyle, and your wrist. In this stage, the signs and symptoms exhibit similarities to a sprained wrist. Vascularized reconstruction of the lunate in kienbock s disease is contraindicated for lunate fracture or collapse with extruded fragments.
Learn how kienbock s disease surgery can relieve your pain and get you back to work and play. A recent trauma may have occurred that plays some role in the lunate becoming avascular without blood supply. The lunate is one of eight small carpal bones in your wrist. The complaint is usually unilateral dorsal wrist pain with a history of trauma or lees specific repetitive injuries. I developed kienbock s disease over a year ago and was wondering if theres a chance it can possibly go away by itself. Revascularization surgery for early kienbocks disease.
Examples of how disease staging has been used to classify patients for a number of applications are highlighted below. For reasons that doctors and researchers dont yet understand, the blood supply to the bone, the lunate is cut off. Genetic and rare diseases information center gard po box 8126, gaithersburg, md 208988126 tollfree. Kienbock s disease affects patients of all ages and either gender. The typical patient with kienbock s disease is a young male with a mechanical job such as carpentry. During the first stage of the disease, the symptoms are similar to those of a wrist sprain. Robert kienbock, a radiologist in vienna, austria who described osteomalacia of the lunate in 1910. In very early stages, the treatment can be as simple as observation or immobilization. Hello, i was diagnosed with kienbock disease and have just had surgery a few days ago. Kienbock s disease affects the lunate bone of your wrist, leading to immobility and pain. In the late stages of the disease, the bone collapses, shifting the position of other bones in the wrist. Results showed a high level of agreement between stages assigned manually using the full. If you are diagnosed with kienbocks disease, your doctor will plan your treatment based on several factors, most importantly, the stage of your progression. Diagnosis and staging kienbock disease arthritis research.
Kienbock s disease is a frequently encountered clinical entity, and mr is the modality of choice for its detection and evaluation. Kienbock s disease is a disease that affects the small bones in the hand, near the wrist. The classification and treatment of kienbocks disease. Longterm natural outcome 726 years of lichtman stage iii. There are 4 stages used to classify kienbock s disease. In stage 1, xrays appear normal, but the lunate has lost its blood supply and is painful and may fracture. Kienbocks disease surgery and recovery michigan surgery. On physical exam he has tenderness over the dorsal radiocarpal joint. Affected people may first think they have a sprained wrist and may have experienced trauma to the wrist, which can disrupt the blood flow to the lunate.
Kienbocks disease musculoskeletal medicine for medical. Recent studies gay et al evaluated the use of a simple capitate osteotomy without arthrodesis, through a dorsal medial approach and fixed with staples, in 11 patients with mild forms stage i to iiia, lichtman classification of kienboc. Kienbocks disease is a condition characterized by interruption of blood supply to one of the small bones of the hand near the wrist the lunate. Kienbocks disease can be difficult to diagnose, especially in its early stages when it resembles a wrist sprain.
Certain cases of kienbock s disease may require more invasive treatment options. Kienbock s disease is a rare and infrequently discussed source of wrist pain that you could definitely encounter in your clinical practice. In early stages of this disease, the xrays may be normal and other tests are needed to confirm the diagnosis. Kienbock s disease occurs when one of the wrist bones named the lunate spontaneously loses its blood supply. Stage 2 might require surgery, usually a radial or ulna shortening but occasionally a partial row carpedectomy.
The anatomic staging of cancer is hallowed by tradition, and for the purpose of analysis of groups of. This article describes the rare condition of kienbocks disease, where the blood supply to the lunate bone is cut off, and the person presents with symptoms which mimic a sprained wrist. Timing of hospitalization 58 disease staging may be used to document potential quality of care problems in. When presented with a patient with stage i kienbock disease, 218 surgeons 74%. This type of lesion can hardly be differentiated from stage i kienbocks disease. Kienbock s disease is a relatively rare disorder that disrupts the blood supply to the lunate.
Kienbock s disease and scaphoid nonunion are extremely painful and debilitating conditions, for which there is no known cause. At first, the person who has kienbock s disease may. Computer software was developed to apply disease staging criteria to automated hospital discharge abstract data. There are a variety of surgical procedures intended to treat keinbocks disease. If you have problems viewing pdf files, download the latest version of adobe reader. Its actual natural history appears in only three papers 68. There need not be a history of antecedent trauma or previous wrist problems. The greater the negative variance, the more severe the disease and the more likely it is to progress. Stahl classification of kienbock disease radiology. The progression of kienbock s disease varies but is usually slow over many years. The condition is named after the viennese radiologist robert kienbock who presented his findings on the disorder in his 1910 publication concerning traumatic malacia of the lunate and its consequences.
Treatment options depend upon the severity and stage of the disease. Doctors will recommend the right procedure for how far their patients case has progressed. Staging and treatment of kienbock disease download table. Kienbock s most commonly affects men between the ages of 20 and 40 years old. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis.
Since the survey software allowed respondents to skip questions without. The greater the extent of viable bone, the better the prognosis. In this stage, persistent pain, swelling, and hardening of the lunate bone in the wrist start to occur, due to interrupted blood flow. Kienbocks disease genetic and rare diseases information. One should be aware that not every case of kienbocks disease progresses through all stages to the severely deteriorated arthritic endstage. For language access assistance, contact the ncats public information officer. Kienbock disease is invariably progressive, and joint destruction occurs within 35 years of onset. Curtis national hand centers signature approach to. For treatment of a young ulnarneutral male with stage i disease who had failed. It is breakdown of the lunate bone, a carpal bone in the wrist that articulates with the radius in the forearm. Stage 0 has also been included in the classification of diseases for patients with a history of a significant predisposing risk factor for the disease, but for whom there. The stage of the disease dictates the goal of the surgery. Kienbock s disease is a condition characterized by interruption of blood supply to one of the small bones of the hand near the wrist the lunate.
He denies systemic symptoms, history of trauma, or recent weight loss. Radial shortening osteotomy with neutral or negative. Kienbock s disease causes a bone in the wrist to deteriorate progressively, leading to pain, swelling and eventually arthritis in the wrist. Download table staging and treatment of kienbock disease from.
The surgical treatment of kienbock s disease depends on the stage of the disease and the structural integrity of the carpus wrist. Disease staging is a valuable tool in many clinical, research, management, and educational studies. The content of the website and databases of the national organization for rare disorders nord is ed and may not be reproduced, copied, downloaded or disseminated, in any way, for any commercial or public purpose, without prior written authorization and approval from nord. Kienbock disease, how long is the progress time to get to stage 4 immobilization for kienbock disease, what to do.
Options for treatment of kienbock s disease based on staging. A patients guide to kienbock s disease introduction. This shifting eventually leads to degenerative changes and osteoarthritis in the joint. Current trends in treatment of kienbock disease ncbi. This software was validated in reabstracting studies that compared manual and computer staging on a large sample of records.