Kienbock Wrist Disease

Question 1

What is Kienbock wrist disease?

Answer 1

1. AVN of the lunate (usually misdiagnosed)
2. Usually affects dominant wrist
   *20-40 age

Question 2

What is the pathophysiology of Kienbock wrist disease

Answer 2

1. Lunate bone losses blood supply and dies
   *will cause pain and stiffness with wrist motion
2. The bone will eventually collapse shifting the position of the other carpal bones
   *leads to degenerative changes

Question 3

What are the risk factors of Kienbock wrist disease

Answer 3

1. History of injury (this alone is not the cause)
2. Negative ulnar variance
   *changes where the pressure is distributed in the wrist

Question 4

What is the clinical presentation of Kienbock wrist disease

Answer 4

1. Wrist pain
2. Swelling
3. Stiffness

Question 5

What will be found on the PE?

Answer 5

1. Tenderness over lunate
2. Edema
3. Decreased ROM
4. Increased pain/weakness to supination

Question 6

What diagnostic test will be completed?

Answer 6

XRays

Question 7

What are the complications of Kienbock wrist disease

Answer 7

1. Difficult diagnosis bc initial symptoms are similar to sprain
   *symptoms and exam are vague

Question 8

What is the treatment of Kienbock wrist disease

Answer 8

1. No definite “cure”
2. May resolve spontaneously
3. Goal is to relieve pressure on the lunate and assist blood flow
4. Immobilization and NSAIDs in earlier stages
   *in attempt to avoid further disruption of blood flow

Question 9

When is surgery indicated?

Answer 9

1. For more advanced disease
   *choice of procedure depends on progression, absence of ulnar variance activity levels, and goals

Question 10

What are the different surgery options?

Answer 10

1. Excision of dead/necrotic bone (may be replaced with soft tissue
2. Joint leveling procedures (can reduce the collapsing force by 70%)
3. Inter carpal fusions
4. Revasculariztion
5. Salvage procedures