Bones Kienbock's Disease Wrist Wrist Pain

Ask a Doctor: Kienbock’s Disease


Dr. Mark Yuhas answers your questions about Kienbock’s Disease:

What is Kienbock’s Disease?

Kienbock’s Disease, also known as avascular necrosis of the lunate, is a disease that can result in pain and stiffness in the wrist. The lunate is one of eight small bones in the wrist that give the wrist its complex and unique motion.  “Avascular necrosis” is a lack of blood supply to the bone, which results in bone death. Blood supply is important to all bones to grow, heal, and provide structure and support to the body. Without blood supply, the lunate may not provide the same support and structure needed for proper wrist function.

What is the cause of Kienbock’s Disease? Can it be prevented?

There are several theories about the cause of Kienbock’s Disease, but a single cause has not been identified. Multiple variables are thought to be involved, including a history of wrist trauma. Other contributing factors include variations in anatomy such as the position of the forearm bones at the wrist, the shape of the lunate, and the pattern of blood supply to the lunate. Most of these factors are not able to be controlled by the patient.

There is no way that we know to prevent Kienbock’s Disease. However, it is important to identify this problem as soon as possible in order to prevent progression of the disease which can lead to wrist arthritis. This ultimately can cause pain, stiffness, and decreased function in the wrist.

How do I know if I have Kienbock’s Disease?

Some typical symptoms for a patient with Kienbock’s Disease include pain and swelling in the wrist, usually on the dorsal (opposite of palm) aspect of the wrist joint. Other symptoms may include decreased strength with gripping, wrist pain with activity, and wrist stiffness.

The problem most often affects males between 20-40 years of age, but females can be affected, and people of all ages can be affected. Pain may be present for months or even years before a diagnosis is made, and early diagnosis can be challenging.

Many other disorders of the wrist can present with similar symptoms, so it is important to discuss these symptoms with a hand specialist to aid in making a diagnosis.

What should I expect when I go to see a hand specialist?

If you have symptoms and a history suspicious for Kienbock’s Disease, further testing will need to be performed. This will typically start with x-rays of the wrist. If there is further uncertainty, or to help with diagnosis and staging the problem, an MRI or CT scan of the wrist is often helpful as well.

Kienbock’s Disease is often classified in “stages” based on the amount of time the lunate has been without blood supply, among other factors. As the lunate loses blood supply, the shape and strength of the bone may change, leading to further changes in the wrist, such as arthritis (loss of smooth cartilage that helps the joint move).

The “stage” of Kienbock’s Disease can be determined with imaging such as x-ray, MRI, and CT scan. This information can help a physician to guide a patient’s treatment options.

What are the treatment options for Kienbock’s Disease?

There are multiple treatment options for Kienbock’s Disease. These options are usually determined by the “stage” or progression of the change in the lunate.

The earliest stages of lunate avascular necrosis may sometimes be treated with nonoperative care. This can involve a wrist brace and promoting rest of the joint and anti-inflammatory medications such as ibuprofen or aspirin.

Often, nonoperative treatment is not effective for this problem and surgical options need to be discussed. Talking with your hand specialist about treatment options is important, as multiple options may be appropriate. Factors that a surgeon may consider in treating a wrist with Kienbock’s Disease include the “stage” of lunate avascular necrosis (such as collapse of the bone or surrounding arthritis in the wrist), age and function of the patient, and the position of the forearm bones relative to each other (also known as ulnar variance).

No matter the treatment, it can be difficult to treat Kienbock’s Disease. Improvement in function, pain, and motion can be achieved with surgery, but expectations should be discussed with your surgeon.

Dr. Mark Yuhas is an Orthopaedic Surgeon who specializes in Hand, Wrist, and Elbow care. He practices with Wellington Orthopaedic and Sports Medicine/ Mercy Orthopaedics and Sports Medicine in Cincinnati, OH. His current interests include trauma of the hand, wrist, and elbow; sports injuries of the upper extremity; and arthritis throughout the hand and wrist.

You may also like
5 common golf injuries
Taking care of a dislocated elbow
Follow The HandCare Blog on Twitter @HandCareMD
  • Ann Young
    August 16, 2019 at 1:06 PM

    I had surgery to my wrist for keinboks. 2 years ago. Can this reoccur. As doctor says this is what is wrong with my wrist again.

  • Missy L
    July 12, 2019 at 4:13 PM

    I had surgery for kienbock’s disease on my right wrist 25 years ago. They shortened the radius bone and I did not have to have fusion and have been fine until recently I broke my right leg in seven places, a tibial Plateau fracture and a trimalleolar ankle fracture. My issue is trying to walk with a walker, which is now causing pain in my right wrist after only 2 minutes of attempting to walk. I’m afraid of damaging the wrist. Is there a wrist splint that is bent so that I can use the walker? Which will help relieve some of the pressure being put on my wrist as I try to walk again?

  • Umakanth
    June 11, 2019 at 9:19 AM

    My daughter an Athelete is the victim of kienbock’s disease further her surgery has failed so how to contact Dr. Mark Yuhas for further opinion and treatment

  • Tammie Sgaggero
    May 28, 2019 at 4:17 PM

    I was diagnosed with Kienbocks disease about 6 weeks ago. I also have carpal tunnel—both in my right hand. The surgeon plans on doing the carpal tunnel surgery and what he calls “core decompression.” Has anybody else experienced this?

  • Tony Kieffer
    February 26, 2019 at 10:48 PM

    I want to know if it will ever heal after surgery or is it stuck with you forever? Because I love to play basketball but I just can’t flick my wrist right anymore😭

  • jody
    February 21, 2019 at 9:42 PM

    I am 3 months post surgery. Proximal row carpectomy. It hurts, it’s weak and little range of motion. I can type (thank goodness). But will the pain go away so it is just loss of motion?

  • Reyna Rachel Favila
    November 10, 2018 at 8:05 PM

    Had a surgery done in 2003 where by the time dr figured out my lunate was collapsing, I had my forearm shortened , and metal bar and screws put in on my left arm. Now 15 years later I’m experiencing tingling and or numbness on the tip of my thumb , pointer finger and my middle finger. Is this the cause of nerve damage? Or another bone or muscle deteorating ?

    • Benjamin Jacobs, MD
      November 13, 2018 at 10:35 AM

      That’s a good question and without knowing the specifics of your problem I can’t be certain, but what you describe sounds a bit like carpal tunnel syndrome. Carpal tunnel syndrome can happen to anyone even without a history of significant wrist problems and is typically due to pressure on the median nerve as it crosses the wrist. You should be evaluated by a healthcare provider familiar with diagnosis and treatment of carpal tunnel syndrome. Not everyone needs treatment for this problem acutely, but you should be evaluated sooner rather than later.

  • Andy
    June 23, 2018 at 5:29 AM

    2 surgeries later and 2 cortisol injections. I dont get it. My wrist had reduced rotation after the first operation, but now my elbow aches too. What am I supposed to do?

  • Ray Castaneda
    March 26, 2018 at 5:16 PM

    Need to know about kienbocks disease. Been suffering for over 35years had 3 surgeries and a full wrist fusion and still in constant pain.

    • Tina
      May 15, 2018 at 6:39 PM

      That sucks…. I’m considering a fusion too.

      I really don’t to. Especially if it’s still gonna be painful after. Wtf!

      I’m looking into the stem cell procedures they are offering in Panama….

      • Denise
        November 28, 2018 at 9:19 PM

        I am also looking into all options for surgery. Diagnosed with Kienbocks 8 years ago, My surgeon keeps telling me to wait until I cannot wait anymore. 4 cortisone shots annually with 1600mg ibuprofen daily was keeping the pain at bay, but not anymore. Has anyone any experience with a prosthetic implant?

Leave a Reply to Tammie Sgaggero Cancel reply

Your Comment*

Your Name*
Your Webpage