Treatment for Kiënbock’s disease will depend on how far the condition has progressed.
How Do You Treat Kiënbock’s Disease?
Early diagnosis allows for conservative non-surgical treatment options:
- Splinting or casting for several weeks can help restore blood flow to the lunate bone.
- Pain and swelling can often be managed with anti-inflammatory medications or cortisone injections.
- Physical therapy can improve range of motion, as well as help the patient learn to move the wrist in a less painful way and reduce continued damage to the bone. OSMI Hand Therapy Center offers specialized hand therapy services in a state-of-the-art atmosphere.
Treatment goals are:
- Restore or preserve wrist functionality
- Reduce pain
- Relieve pressure on the lunate bone
- Restore blood flow within the lunate bone
In cases of more advanced Kiënbock’s disease or if conservative treatments are not effective, your orthopedic specialist may recommend one of several surgical options, depending on how far your condition has progressed, your goals, and your level of activity.
Surgical treatment options for Kiënbock’s disease include:
- Revascularization: During this procedure, the orthopedic surgeon removes a portion of bone and blood vessels from another area (often an adjacent wrist bone or the radius) and grafts it into the lunate bone to restore blood supply. This vascularized graft is most successful if performed during stage 1 or 2 of Kiënbock’s disease before the lunate bone has deteriorated extensively. A metal external fixator with pins inserted into the bones may be utilized to keep the bones in place during healing.
- Capitate-shortening osteotomy: A piece of the capitate bone is removed, and the remaining segments of the bone are fused together, usually performed in conjunction with revascularization.
- Joint leveling: This procedure is used when the ulna and radius are different lengths. Bone grafts may be performed to lengthen a bone, or the longer bone may be shortened. Joint leveling can reduce pressure on the lunate when the bone length differential is causing the compression.
- Metaphyseal core decompression: The forearm bones, ulna and radius, are leveled through scraping, and no osseous tissue is removed.
- Proximal row carpectomy (PRC): The lunate bone and 2 adjacent bones are removed to reduce pain. PRC is performed if the lunate is collapsed or broken into pieces during later stages of Kiënbock’s disease. After a PRC, the patient has limited wrist movement.
- Fusion: Wrist bones can be fused together into a solid bone to relieve pain. If a partial fusion is performed, the patient can maintain some wrist movement and improved hand function. A total fusion is performed if severe arthritis is a factor, in which case wrist movement is eliminated but forearm rotation is maintained. Once the wrist bones are fused, they are kept in place with a plate, pins, and screws internally.
- Arthroscopy: The lunate bone can be replaced with an artificial bone made of a specialized pyrolytic carbon material. While this procedure is just recently being utilized, it has been successful in preserving the anatomy of the surrounding wrist bones for Kiënbock’s disease patients.
Recovering from Kiënbock’s disease surgery can take several months, during which a cast may be required. Hand therapy will be an integral part of maintaining wrist function and regaining wrist strength. The prognosis for Kiënbock’s disease patients depends largely on how early the condition is diagnosed and its rate of progression. Some patients need multiple procedures during the course of their treatment. While normal wrist function may never be achieved, medical treatment is the best method for preserving some functionality and relieving pain.
If you are experiencing wrist pain or swelling and/or other symptoms of Kiënbock’s disease, contact the orthopedic and hand specialists at OSMI Ft. Worth for an evaluation.
The Hand Therapy Center at the Orthopedic & Sports Medicine Institute (OSMI) in Fort Worth provides comprehensive hand physical therapy and rehabilitation services by our group of board-certified hand therapists (CHT) who treat a large variety of injuries and disabilities of the fingers, hand, arm and shoulder.
If you are ready to choose a team of hand, wrist and elbow orthopedic and sports medicine specialists that offer state-of-the-art treatment and highly personalized care, contact the OSMI office or call 817-529-1900 today!