Feb 09, 2014 avascular necrosis of the lunate bone kienbocks disease, is a condition in which lunate bone, loses its blood supply, leading to necrosis of the bone. These surgical methods have some disadvantages, such as large, invasive, and complicated procedures and uncertain lunate bone regeneration. Is from something called avascular necrosis, when the blood supply to the lunate diminished. Kienbocks disease, or avascular necrosis of the lunate, is a progressive disease ultimately resulting in endstage arthrosis of the wrist. Makinomagnetic resonance imaging in kienbocks disease. At mri, uniformly decreased signal intensity on t1weighted images and increased signal intensity on t2weighted images are typically found.
It usually affects the dominant wrist of men aged 2040 years, but can effect women, but usually later than in men. Home kienbock disease musculoskeletal mri kienbocks disease. Avascular necrosis of the lunate bone kienbocks disease. The modified lichtman classification, based on radiological and mri findings, is used to guide management of kienbocks disease. Jun 27, 2012 kienbocks disease is a rare and infrequently discussed source of wrist pain that you could definitely encounter in your clinical practice. Apr 25, 2020 treatment options are directed toward the pancarpal arthritis, and include proximal row carpectomy, total wrist. Similar changes of lunate in anatomical specimen was reported by peste in 1843, but kienbocks report was the first clinical report. Negative ulnar variance was identified by olle hulten in 1927 as a predisposing factor for kienbock disease. Advances in mri magnetic resonance imaging technology have improved the outcomes for some conditions.
A patients guide to kienbocks disease introduction. Its origin may involve multiple factors, such as the blood supply arteries, blood drainage veins, and skeletal variations. Kienbocks disease is the eponym used to describe spontaneous osteonecrosis of the lunate. Depending on the stage the disease is in when it is discovered, varying treatments are applied. Michael and rebecca mcgoodwin endowment for radiology resident and fellow. It is important to get a clear history from the patient and examine the wrist very carefully.
It should be noted that in kienbocks disease, t1weighted mri signal intensity is decreased and diffusely involves the lunate in its entirety fig. The symptom information on this page attempts to provide a list of some possible signs and symptoms of kienbock disease. Kienbocks disease was first described in 1910 by dr. Kienbocks disease can eventually affect the structure and function of the wrist. Although, patient lost followup and diagnosis could not be confirmed. The cause of kienbock disease is thought to be due to mechanical or vascular causes. Ocd usually causes pain and swelling of the affected joint which catches and locks during movement. Dont feel frustrated that you are confused about what to do, even after you read this. Kienbock disease is the eponymous name given to avascular necrosis aseptic necrosis involving the lunate.
Kienbock s disease, also known as avascular necrosis of the lunate, occurs when one of the eight small carpal bones in the wrist the lunate bone becomes damaged because its blood supply is lost. Heres a look at the signs and symptoms, causes and treatment from your hand therapist. Frontal view of the hand and wrist demonstrates sclerosis of the lunate white arrow. Welcome to peak performance physical therapys patient resource about kienbocks disease. Mri is likely to be the next best imaging examination after routine radiography. Lunate dislocation results in displacement of rotation of lunate without causing any change in the position of other carpal bones. Other bones in the wrist can get a similar condition but theres no link between keinbocks and these other problems. Kienbocks disease is a progressive condition that affects the lunate bone in the wrist. The overall results were evaluated using the mayo wrist score and nakamura scoring system for kienbocks disease. Imaging tests, such as xrays and magnetic resonance imaging mri scans, are used to confirm a diagnosis of kienbocks disease.
The rise in healthcare costs is of major concern to all governments and healthcare systems. If xrays show a mostly intact lunate not having lost a great deal of size, and not having been compressed into a triangular shape, but an mri shows a lack of blood flow to the bone, then revascularization is normally attempted. Frontal view of the hand and wrist demonstrates sclerosis, irregularity and collapse of the lunate blue arrows. The incentives for developing a nonsurgical protocol for early stages of this disease were the patients with clinical and mri changes in the lunate but no clearcut kienbock s disease. Nonetheless, the radiological findings within the lunate bone of kienbocks are often very similar to other pathological conditions, which leads to a common misinterpretation. Indroduction kienbock diseas is an isolated disorder of lunate resulting from vascular compromise to the bone avascular necrosisosteomalacia of lunate dr robert kienbock 1910 he described step wise progression disease from isolated proximal lunate involvement,to. A hand therapy protocol for the treatment of lunate overload. In the late stages of the disease, the bone collapses, shifting the position of other bones in the wrist. Kienbocks disease is primarily diagnosed through the use of the imaging modalities.
Kienbocks disease progresses through four stages of severity. Kienbocks disease journal of the american academy of orthopaedic surgeons bocks disease, but neither is likely to be the sole factor. Sep 27, 2019 kienbock disease is a condition of uncertain etiology that results in osteonecrosis of the carpal lunate. A lunate dislocation is a rare case of traumatic wrist injury which must be attended immediately and repaired with proper lunate dislocation surgery. The imaging criteria for kienbock disease are based on bone hyperdensity and hyperattenuation radiography and ct and the degree of collapse of the lunate bone radiography, ct, and mri. Kienbock s disease is a progressive wrist disorder characterized by osteonecrosis of the lunate. The diagnosis of kienbocks disease is made by history, physical examination, and plain xrays. Magnetic resonance imaging mri may also be helpful in making the diagnosis in this early stage. A magnetic resonance imaging mri scan picks up very early changes in the lunate, even when the xrays are normal, and is the most sensitive test for this condition. Each imaging modality plays a specific role in the diagnosis and staging of the disease. Various surgical treatments are available for different lichtman stages of disease. The treatment of kienbock s disease remains controversial, although numerous surgical procedures have been described 110.
Special studies are sometimes also needed to confirm the diagnosis. Xrays may be normal or show a line indicating a possible fracture. May 16, 2017 kienbocks disease is a relatively rare disorder that disrupts the blood supply to the lunate. Lunate dislocationcausessymptomstreatmentrepairbraces. Features are almost characteristic of kienbocks disease. Physical therapist practice and the role of diagnostic. The etiology, pathophysiology, and treatment remain controversial. My experience with kienbocks disease peachlovehappiness. Kienbocks disease physical therapy patient education. 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. Kleinert kutz hand care center diagnose and treat a wide variety of hand, wrist and arm conditions.
Kienbock disease, lunatomalacia learning radiology. 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. Kienbocks 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. The age distribution for kienbock disease depends on gender. Physical therapy in baton rouge for wrist kienbocks disease. Bcbsnj medical policy for radiology policy number 152. C,d repeat mri 4 months after arthroscopic debridement.
Mri is useful in diagnosis and staging and should be considered, after conventional radiography, for patients with suspected kienbock disease. Application of the therapy protocol improved objective and subjective parameters such as pain and motion, and may provide a viable treatment option for patients with lunate overload or early kienbock s disease that are not candidates for surgery. Standard protocols can now be implemented on uptodate scanners, allowing mri to be used as a firstline imaging modality. Kienbock disease kd is a disease of uncertain etiology, leading to chondral and osseous change in the lunate and wrist. For language access assistance, contact the ncats public information officer. If you have problems viewing pdf files, download the latest version of adobe reader.
A hand therapy protocol for the treatment of lunate. Mar 18, 2017 a pa radiograph of a wrist in a 11yearold female showing sclerosis of the lunate with no collapse. Treatment options are directed toward the pancarpal arthritis, and include proximal row carpectomy, total wrist. It occurs when there is a disruption of the blood supply to the lunate bone.
This page is designed to help you better understand your condition, not make you an expert. Initial treatment of kienbocks disease is typically nonsurgical by. Kienbock disease is the eponymous name given to osteonecrosis involving the lunate. Kienbocks disease follows a specific progressive pattern through four stages. Genetic and rare diseases information center gard po box 8126, gaithersburg, md 208988126 tollfree. A comparison of the preoperative and postoperative radiographs and magnetic resonance imaging studies showed evidence of lunate revascularization and remodeling after a radial shortening osteotomy. Before mri became available, the disease was diagnosed clinically or with scintigraphy. Kienbocks disease is a rare condition which affects the lunate bone in the wrist. 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. Magnetic resonance imaging mri was performed for all patients. Even the experts are not sure what to do about keinbocks disease. This is an extremely sensitive test for detecting changes in marrow fat that are consistent with, but not diagnostic of, osteonecrosis.
Kienbocks disease tuesday, september 09, 2008 kienbock disease, musculoskeletal mri. There is probably no single cause of kienbocks disease. The lunate is one of eight small carpal bones in your wrist. Traditionally, lichtmans classification of kd, based on radiographic. Kienbocks disease surgery and recovery michigan surgery. Its at the middle of the base of your wrist and important for wrist movement. Kienbocks disease affects the lunate bone of your wrist, leading to immobility and pain. Osteochondritis dissecans ocd or od is a joint disorder in which cracks form in the articular cartilage and the underlying subchondral bone. Kienbock s disease is a relatively rare disorder that disrupts the blood supply to the lunate. May 29, 2017 kienbocks disease is a rare condition which affects the lunate bone in the wrist. New capabilities of computed tomography ct and magnetic resonance imaging mri have improved image quality due to both spatial resolution and contrast resolution with the use of gadolinium in mri. It occurs when there is disruption in the blood supply to the lunate bone. Aug 24, 2016 xrays may show no specific abnormality in the early stages and so mri scans are essential if early kienbocks disease is suspected. In this retrospective study on kienbocks disease, a comparison was made between 21 cases operated on by various techniques and 22 cases treated conservatively, with a mean followup of 65 months.
This bone is important for movement and stability in the wrist. This disease is rare in pediatric and adolescent patients and accounts for 1 % of all patients with kienbocks disease. We describe our protocol and a series of patients with evidence of lunate overload. Highresolution images are critical when small joints are involved. The true natural history what happens if we do not treat it of this condition is not well understood. Mri can depict the bone anatomy and, like radiography and ct, can be used to determine the lichtman stage of disease. During the past decade significant developments have been achieved in the field of magnetic resonance imaging mri, enabling mri to enter the clinical arena of chest imaging. Physical examination typically reveals an effusion, tenderness, and a crackling sound with joint movement ocd is caused by blood. Know the causes, symptoms, treatment, repair and prevention of lunate dislocation. It is breakdown of the lunate bone, a carpal bone in the wrist that articulates with the radius in the forearm.
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. Thirteen patients with scaphoid fractures and four patients with kienbocks disease of the lunate underwent magnetic resonance imaging mri prior to surgery. Xrays may be normal or suggest a possible fracture. Radiologic guide to surgical treatment of kienbocks disease. Kienbocks disease genetic and rare diseases information. 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. Kienbock disease is a condition marked by avascular necrosis of the lunate bone. In its early stages, kienbocks disease may be difficult for your doctor to diagnose because the symptoms are so similar to those of a sprained wrist. Etiology the cause of kienbock disease is thought to be due to mechanical or vascular causes. Avascular necrosis of the lunate leading to abnormal carpal motion. This signs and symptoms information for kienbock disease has been gathered from various sources, may not be fully accurate, and may not be the full list of kienbock disease signs. Preoperative tlweighted a and t2weighted b mri of a 15yearold male with stage i disease and symptoms for over 12 months.
Probably the most reliable special study to assess the blood supply of the lunate is magnetic resonance imaging, or mri. Mri is accurate for appreciating the morphologic changes in the lunate bone and differentiating all disease stages. Kienbocks, stage iiia with slightly negative ulnar variance age 4050. The patients were not candidates for surgical treatment. Does kienbock disease spread to other bones to the wrist. Learn more of its signs and symptoms, causes and treatment. The condition is generally believed to be caused by a loss of blood supply to a bone in the wrist lunate. Radiologic imaging, such as mri and ctscans, in case of kienbocks disease is generally the only way to give a correct diagnosis. Kienbocks disease is a fairly rare condition affecting one of eight small carpal bones in the wrist, the lunate bone. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis.
767 235 447 1502 60 1549 452 974 957 1316 1387 562 1207 418 146 13 1445 344 252 413 234 437 146 636 1190 915 903 957 301 868 1228 603 1246 1198 1281 918 275 269 667 511 158 513 284 806 1373 757 565 825