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Go with the Flow: A Simpler Way to Restore Circulation in Wrists with Kienböck's Disease

Kienböck's disease happens when a small wrist bone, the lunate, loses its blood supply. The bone begins to die, leading to a condition called avascular necrosis.

With Kienböck's disease, the two bones in the forearm that control wrist rotation may grow to different lengths. The radius, which is on the thumb side of the forearm, may get longer than the ulna on the little-finger side. Kienböck's disease has often been treated by surgically "leveling" or evening out these bones--either shortening the radius or lengthening the ulna where the bones meet in the wrist.

These authors have a new surgical treatment for Kienböck's disease. They simply make a "window" in the radius and/or ulna for blood to flow through. But does this "decompression" procedure reduce pain and restore movement in the wrist?

Twenty-two patients had this procedure. Sixteen patients were male; six were female. Their average age was 36. About half were manual laborers. The other half had office jobs. All of the patients had pain and poor movement in one of their wrists. Their Kienböck's disease was early to moderate.

There were no complications from surgery, and no patients had more surgery. Many patients had almost immediate pain relief. Six to 16 years after surgery (average 10 years), 91 percent of them had less pain than before surgery. Sixteen of them (72 percent) were completely pain-free. Four had only mild pain from time to time. One patient had moderate pain, and one had severe pain. With these two exceptions, all of the patients were able to go back to their former jobs.

Wrist movement and strength also improved. At follow-up, range of movement in the wrists that were operated on was 77 percent of patients' opposite wrists. And grip strength was 75 percent. These results were on par with those of other surgical treatments for Kienböck's disease.

Follow-up X-rays showed that 17 of the 22 patients were at the same stage of disease as they had been before surgery. Two patients had improved, and three had gotten worse. In general, the position of bones in the forearms and wrists stayed the same after surgery. However, blood flow seemed to improve over the follow-up period, as shown by MRI for a small set of patients.

There were no differences between patients who had both the radius and ulna treated with the decompression procedure, and the three patients who only had the radius treated. The authors think that working on the radius alone, or the radius in combination with the ulna, helps improve blood flow to the wrist. This can happen without changing the length of the bones.

The authors conclude that this simple surgery gives lasting pain relief. The results are similar to those of the bone leveling procedures. However, because the decompression procedure has fewer complications and doesn't involve bone implants, it is especially noteworthy. More research is needed to understand exactly how this and other surgeries improve blood flow in patients with Kienböck's disease.

Aldo A. Illarramendi, MD, et al. The Surgical Treatment of Kienböck's Disease by Radius and Ulna Metaphyseal Core Decompression. In The Journal of Hand Surgery. March 2001. Vol. 26A. No. 2. Pp. 252-260.


*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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