Kienbock's Disease
Kienbock's Disease: A Comprehensive Overview
Kienbock's disease is a rare bone disorder affecting the lunate, one of the eight small bones in the wrist. It is characterized by avascular necrosis (bone tissue death) due to interrupted blood supply, primarily affecting men aged 20-40 and rarely occurring in both wrists.
Etiology and Risk Factors:
- Trauma to the wrist
- Uneven forearm bone lengths (shorter ulna compared to radius)
- Irregular lunate bone shape
- Medical conditions compromising blood supply
Disease Progression:
- Initial blood supply loss with minor symptoms
- Lunate bone hardening
- Bone fragmentation and partial collapse
- Complete bone collapse affecting surrounding structures
Clinical Manifestations:
- Wrist pain and tenderness
- Limited movement
- Stiffness and swelling
- Decreased grip strength
Diagnostic Approach:
- X-ray imaging
- MRI scans
- Arthroscopic procedures
Treatment Strategies:
- Anti-inflammatory medications
- Wrist immobilization (cast or splint)
- Surgical interventions:
- Bone shortening
- Joint fusion
- Nerve intervention
Prognosis: While no complete cure exists, appropriate treatment can provide long-term pain relief and preserve wrist function.
References:
[1] Lichtman DM, Lesley NE, Simmons SP. The classification and treatment of Kienbock's disease: the state of the art and a look at the future. J Hand Surg Eur Vol. 2010 Sep;35(7):549-54. doi: 10.1177/1753193410374690. Epub 2010 Jul 9. PMID: 20621943. [L]
[2] Schuind F, Eslami S, Ledoux P. Kienbock's disease. J Bone Joint Surg Br. 2008 Feb;90(2):133-9. doi: 10.1302/0301-620X.90B2.20112. PMID: 18256076. [L]
[3] Allan CH, Joshi A, Lichtman DM. Kienbock's disease: diagnosis and treatment. J Am Acad Orthop Surg. 2001 Mar-Apr;9(2):128-36. doi: 10.5435/00124635-200103000-00006. PMID: 11281636. [L]
[4] Danoff JR, Cuellar DO, O J, Strauch RJ. The Management of Kienböck Disease: A Survey of the ASSH Membership. J Wrist Surg. 2015 Feb;4(1):43-8. doi: 10.1055/s-0035-1544225. Erratum in: J Wrist Surg. 2015 May;4(2):148. doi: 10.1055/s-0035-1550427. PMID: 25709878; PMCID: PMC4327716. [L]
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