Thumb base arthritis
Kienböck’s Disease (Lunate Avascular Necrosis)
What is Kienböck’s Disease?
Kienböck’s disease is a condition in which the lunate, one of the carpal bones in the wrist, loses its blood supply. This leads to weakening and collapse of the bone over time, resulting in pain, stiffness, and reduced wrist function.
The lunate sits in the centre of the wrist and plays an important role in wrist movement and stability. When its blood supply is disrupted, the bone may gradually become damaged, leading to progressive wrist problems.
Kienböck’s disease often develops gradually but may sometimes follow an injury. Without treatment, the condition may progress and lead to wrist arthritis.
Causes and Risk Factors
The exact cause of Kienböck’s disease is not always clear, and it is considered multifactorial.
Factors that may contribute include:
Reduced Blood Supply
The lunate has a relatively delicate blood supply, making it vulnerable to injury or disruption.
Previous Injury
A fall or repeated trauma to the wrist may damage the blood supply to the lunate.
Ulnar Variance
Some individuals have a shorter ulna relative to the radius (negative ulnar variance), which may increase pressure on the lunate and contribute to the development of the condition.
Repetitive Wrist Loading
Occupations or activities involving repetitive wrist stress may increase the risk.
Age
Kienböck’s disease most commonly affects adults between 20 and 40 years of age, although it can occur at other ages.
Symptoms
Symptoms of Kienböck’s disease often develop gradually but may worsen over time.
Common signs include:
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Pain in the centre or back of the wrist
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Swelling around the wrist
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Stiffness and reduced wrist movement
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Weakness when gripping objects
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Tenderness over the centre of the wrist
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Reduced grip strength
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Difficulty performing tasks that require wrist movement
In more advanced cases, symptoms may include:
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Persistent pain even at rest
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Progressive loss of wrist movement
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Worsening grip strength
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Development of wrist arthritis
Diagnosis & Investigation
Kienböck’s disease is diagnosed based on clinical history and physical examination, supported by imaging.
During your visit:
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The surgeon will ask about wrist pain, duration of symptoms, and any previous injuries.
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A physical examination will assess tenderness, movement, grip strength, and wrist function.
Imaging
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X-rays are usually performed initially and may show changes in the lunate bone.
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MRI scans are particularly useful in detecting early disease before changes are visible on X-rays and in assessing blood supply to the lunate.
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CT scans may be used to assess bone structure and plan surgical treatment.
The condition is often classified into stages, which help guide treatment decisions.
Non-Surgical Treatment
Early-stage Kienböck’s disease may sometimes be treated without surgery.
Non-surgical treatment options may include:
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Splinting or casting, to reduce stress on the lunate
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Activity modification, avoiding heavy or repetitive wrist loading
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Pain relief medication, such as paracetamol or anti-inflammatory medication
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Hand therapy, to maintain movement and strength
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Regular monitoring with imaging
These treatments aim to reduce symptoms and slow progression of the disease.
Surgical Treatment
Surgical treatment may be recommended depending on the stage of the disease, symptoms, and wrist function.
Common surgical options include:
Joint Levelling Procedures
These procedures aim to reduce pressure on the lunate.
Examples include:
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Radial shortening osteotomy, where a small section of the radius is removed
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Ulnar lengthening osteotomy, in selected cases
These procedures are often used in earlier stages of the disease, particularly when negative ulnar variance is present.
Revascularisation Procedures
In some cases, surgery may be performed to improve blood supply to the lunate using a vascularised bone graft. This involves transferring bone with its own blood supply to support healing.
Proximal Row Carpectomy (PRC)
This procedure involves removing several carpal bones, including the lunate, to reduce pain and preserve wrist movement. It is often used in more advanced stages of the disease.
Partial Wrist Fusion
This involves fusing selected carpal bones to stabilise the wrist while maintaining some movement.
Total Wrist Fusion
In severe cases, particularly when arthritis has developed, total wrist fusion may be performed to relieve pain. This procedure eliminates wrist movement but provides reliable pain relief.
Recovery
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Recovery following treatment depends on the stage of the disease and the procedure performed.
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Immobilisation is usually required following surgery.
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Hand therapy is usually recommended to restore strength and function.
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Recovery may be gradual, particularly following reconstructive procedures.
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Recovery times vary depending on treatment:
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Joint levelling procedures typically require a period of bone healing before full activity resumes.
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Revascularisation procedures require careful rehabilitation.
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Proximal row carpectomy and partial wrist fusion require structured rehabilitation.
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Total wrist fusion requires longer immobilisation and gradual return to activities.
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Full recovery may take several months.
Risks
Although treatment is usually successful, complications can occur, including:
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Persistent pain
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Stiffness
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Reduced wrist movement
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Progression of disease
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Development of arthritis
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Non-union following bone procedures
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Infection (after surgery)
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Nerve injury
Early diagnosis improves outcomes.
When to See One of Our Hand Specialists
You should consult a hand specialist if:
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You have persistent wrist pain, particularly in the centre of the wrist
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You notice reduced wrist movement
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Your grip strength is decreasing
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Symptoms are not improving with rest
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You have ongoing wrist pain following an injury
If you have sustained a severe injury, have significant deformity, or have an open wound associated with a fracture or ligament injury, this should be assessed urgently in the Emergency Department (A&E).
