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Beverly Hills
9301 Wilshire Boulevard
Beverly Hills, California 90210
West Hills
7301 Medical Center Drive
West Hills, California 91307
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Kienböck's Disease
Causes of Kienböck's Disease
Symptoms & Diagnosis
Progression of the Disease
Non-Surgical & Surgical Treatments
Recovery & Severity of the Disease
Kienböck's disease impacts one of the eight carpal bones in the
wrist, the lunate, and is caused by a problem in the wrist that causes
that bone to have a loss of blood. Inside the wrist there are two
rows of small bones. The row closer to the forearm is called the proximal
row while the row closer to the fingers is the distal row. The lunate
bone is in the middle of the proximal bone, directly next to the scaphoid.
| Causes of Kienböck's Disease |
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There can be several causes for the lunate to lose blood supply, and
more than one factor seems to contribute to Kienböck's disease.
These factors may relate to the arteries, which supply the blood,
the veins that remove the blood, and variations in how the bones are
formed and arranged.
The different skeletal factors that can cause Kienböck's disease
include the shape of the lunate itself. Additionally, skeletal factors
related to the ulna, a bone in the forearm, being shorter than usual
may play a role. Some cases of Kienböck's disease are associated
with other diseases such as cerebral palsy, sickle cell anemia, and
gout.
The blood supply to the lunate can also be reduced from a traumatic
injury or a series of significant injuries. Kienböck's disease,
however, isn't believed to result from any specific occupational hazard.
The disease, however, impacts the treatment course for traumatic events
and the chances for a full recovery.
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| Symptoms & Diagnosis |
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The most common symptoms of Kienböck's disease are pain in the
wrist and tenderness in the lunate bone. Ordinary x-rays, the patient's
history, and an effective examination are all used to assist in the
diagnosis. Additionally, certain studies are often used to confirm
the presence of the disease. For example, an MRI may be used to determine
the supply of blood to the lunate or a CRT may be used to examine
the bone.
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| Progression of the Disease |
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Patients with Kienböck's disease can have a variety of problems
as the disease progresses, and they don't show up in any particular
order. If the disease is detected early on, pain and swelling may
be the only symptoms apparent. If left untreated, however, the lunate
bone will change; these changes will be evident in x-rays. As the
disease progresses, the lunate will consists of small fractures before
ultimately fragmenting and collapsing.
When the lunate collapses, movement and function of the wrist will
change thus leading to unusual wear and stress on the joints inside
the wrist. Not every case of Kienböck's disease, however, leads
to this severely deteriorated stage of arthritis.
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| Non-Surgical & Surgical Treatments |
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There are several courses of action that can be taken to treat Kienböck's
disease. In its earliest stages, keeping an eye on the wrist and immobilizing
it with a splint may be sufficient. As the disease progresses, your
hand surgeon might need to reduce the amount of work the lunate is
subjected to by surgically fusing, shortening, or lengthening some
of the bones in the wrist. More extensive surgical facilitation may
require removal of any diseased bone or grafting a new bone into the
wrist. If the disease has progressed to a very advanced state and
the workings of the bones in the wrist have deteriorated a great deal,
it may be necessary to completely fuse the bones in the wrist.
While hand therapy does not, in itself, change how the disease progresses
it can help lessen any disability that the patient feels. Along with
therapy, treatment by one of our qualified hand surgeons can help
relieve the pain and assist in getting wrist function back to normal
range.
After examining the wrist carefully, our hand surgeons will determine
the best course of action for treatment of the disease. This treatment
plan will be discussed with you at great length. During the discussion,
a hand doctor will review the benefits of the treatment options along
with any possible risks or side-effects.
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| Recovery & Severity of the Disease |
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The long-term effects of Kienböck's disease and the proper course
for treatment will depend on the severity of the disease. Typically,
the course of the disease and its response to treatment may require
several months of careful observation. Sometimes several different
courses of treatment options, including more than one surgical intervention,
may be needed.
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