Los Angeles Hand Surgeon

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Arthritis at Base of Thumb
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Kienböck's Disease
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Diagnosis Model
Hand Diagnosis Model


Call our offices at:
(310) 274-3481
(800) 964-0404

Beverly Hills
9301 Wilshire Boulevard
Suite 406A
Beverly Hills, California 90210

We accept most types of insurance providers and specialize in the treatment of workers' compensation injuries to the hand and upper extremity.

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.

Kienböck's Disease

Causes of Kienböck's Disease
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
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
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
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
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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We serve the following cities within Los Angeles, which are in close proximity to our offices:
Agoura Hills, Brentwood, Canoga Park, Century City, Chatsworth, Culver City, Glendale, Granada Hills, Hollywood, Los Angeles, Marina Del Rey, North Hollywood, Northridge, Rancho Park, Reseda, Santa Monica, Sherman Oaks, Studio City, Tarzana, Valencia, Van Nuys, West Hills, West Hollywood, West L.A., Winnetka, Woodland Hills