Summary :
\n\nKienböck disease is an avascular necrosis of one of the wrist bones, the lunate bone (also called the semilunar bone). Avascular necrosis means that the bone gradually dies because blood vessels no longer supply sufficient blood to the bone tissue.
\nThis necrosis gradually leads to wrist pain, followed by deformation and fragmentation of the lunate bone. This deformation causes progressive destruction of the entire wrist, resulting in stiffness and loss of functional use.
\nThere are no consequences of this disease outside the affected wrist; the rest of the body is unaffected.
\nThe causes of Kienböck disease are not yet fully understood. It is a rare condition, more commonly affecting young men.
\nThe causes are still unclear and likely multifactorial. Having a relatively longer radius compared to the ulna (also called the cubitus), sustaining a major wrist hyperextension injury, or repeated microtrauma are considered risk factors.
\nThe clinical signs of Kienböck disease are non-specific. Patients are usually young adults. They experience chronic wrist pain without a clear initial cause.
\nThis pain gradually worsens. It increases when the wrist is under load and in hyperextension (for example, during push-ups).
\nStiffness develops progressively, with reduced wrist flexion and extension, along with loss of strength.
\nOnly additional imaging tests can confirm the diagnosis of Kienböck disease. They also help determine the stage of the disease.
\nOnce diagnosed, four main stages can be defined depending on the extent of lunate involvement, ranging from simple signal changes to bone fragmentation and possible involvement of adjacent bones.
\nTreatment of Kienböck disease is mainly surgical. However, wrist splinting and removal of aggravating factors (sport, work activity, smoking, etc.) may be attempted in very early stages.
\nWithout treatment, the natural progression leads to worsening destruction of the lunate and then the entire wrist. Therefore, the earlier the surgical treatment, the less invasive the procedure and the better the outcome.
\nIn early stages where the lunate is not deformed or fragmented, the goal is to preserve the bone and promote revascularization and healing.
\nPossible procedures, depending on stage, patient profile, and surgeon preference, include radial shortening osteotomy or microsurgical revascularization of the lunate.
\nRadial shortening is performed via an osteotomy, reducing pressure on the lunate and promoting revascularization, particularly in early stages or when the radius is naturally longer than the ulna.
\nA segment of the radius is removed, and the bone is fixed using a plate and screws. In a similar but less common procedure, the bone located beneath the lunate—the capitate bone—may also be shortened.
\n\nMicrosurgical revascularization involves implanting blood vessels to restore blood supply to the lunate. This procedure may be performed through a dorsal incision or combined with wrist arthroscopy.
\nIn more advanced cases, the lunate is too damaged to be preserved and must be removed before it damages the surrounding wrist bones.
\nSeveral techniques may be considered: proximal row carpectomy, implant placement, and arthroscopy.
\nProximal row carpectomy involves removing the lunate as well as the two adjacent bones, the scaphoid and triquetrum.
\nThe capitate bone then articulates directly with the radius.
\nWhen performed early enough, this procedure preserves a functional wrist and allows most daily activities to resume, with significant pain relief. However, it results in reduced wrist flexion and extension and sometimes decreased grip strength.
\nThere are no cosmetic consequences to this procedure.
\nThe placement of a pyrocarbon or silicone implant may sometimes be considered instead of the lunate.
\n\nWrist arthroscopy is a minimally invasive technique that, in some cases, allows removal of only the most damaged part of the lunate using small incisions and miniature instruments.
\nThis technique is appealing and minimally disabling, but it is not always possible. During a preoperative consultation, the surgeon will determine whether it is appropriate for your case.
\nIn the most advanced cases, where the necrotic lunate has damaged the other carpal bones and the radius, wrist arthrodesis is the best surgical option.
\nThis procedure completely fuses the wrist bones using a plate and screws.
\nThe wrist then loses all flexion and extension mobility. However, forearm rotation (pronation/supination), finger movement, and strength are preserved. Pain is significantly reduced or eliminated, and the wrist becomes stable and functional for daily and manual work activities.
\nWrist denervation is another palliative procedure that may be considered when symptoms are tolerable despite bone damage.
\nThis microsurgical procedure involves selectively cutting sensory nerve branches to the joint, reducing pain without affecting wrist mobility. However, the disease progression is not stopped.
\nIt is important to remember that this is a relatively rare disease requiring specialist care.
\nTreatment decisions are closely linked to disease stage, impact on the patient’s life, and overall health profile.
\nManagement is therefore decided on a case-by-case basis.
\nWithout treatment, the natural progression leads to destruction of the lunate and then the wrist, causing pain and stiffness that severely limit hand and wrist function.
\nAvailable treatments generally help improve or stabilize the condition, preserving a functional wrist and hand, although some loss of motion and residual pain may persist depending on the procedure.
\nComplications after surgery for Kienböck disease are rare. However, postoperative recovery is often long. To achieve the best possible outcome, the patient must be motivated for surgery, immobilization, and rehabilitation.
\nPain may persist for several months after surgical treatment of Kienböck disease.
\nAlthough rare and unpredictable, surgical procedures carry risks that must be weighed against the benefits.
\nAmong the risks associated with Kienböck disease:
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