Houston Methodist. Leading Medicine

Wrist FAQ

Question:

I have a wrist problem called Kienböck Disease. I've seen two surgeons who both want to do surgery. One suggested grafting a piece of bone to that area to help restore the blood supply. The other wants to shorten one of the bones in my forearm. Neither one of these appeals to me. Is there some other way to handle this problem?

Answer:

Treatment of Kienböck Disease is usually directed toward taking pressure off the affected carpal (wrist) bone (the lunate). Preventing collapse of the lunate and helping to restore blood flow to the area are the two main goals of treatment. Transplantation of a bone graft with an intact blood supply is one way to accomplish this. But the graft doesn't always "take" and further surgery may be needed. A second common approach is joint-leveling. Here's a brief explanation of why joint-leveling is used. Some experts think that a difference in length between the two bones of the forearm (radius and ulna) adds stress and pressure on the lunate. When the ulna is shorter than the radius, an imbalance of pressure is created in the wrist joint. Normally, the ulna supports a portion of the force that needs to be transferred from the hand to the forearm. If the ulna is too short, this cannot occur. The lunate is caught between the capitate bone and the radius and must absorb more force when the hand is used for heavy gripping activities. Over time, this extra force may make it more likely for a person to develop Kienböck disease. Chronic repetitive trauma can lead to damage of the arteries supplying blood to the lunate. A joint-leveling operation either shortens the bone that is too long (the radius) or lengthens the bone that is too short (the ulna). Joint leveling operations include ulnar lengthening and radial shortening osteotomy. But this procedure has come under question because of the many complications associated with it and also because the problem has been successfully treated in other ways. One of those other simpler yet still effective treatment techniques may be of interest to you. It's called lunate core decompression. This procedure doesn't involve bone graft or removing bone. Instead, a small hole is drilled into the center of the bone. After surgery, the drill hole gradually fills with tissue. Sometimes, new bone forms within this area. The procedure may help increase the blood flow to the diseased area of bone and allow new blood vessels to form. Core decompression appears to slow down the disease process. It may even stop the progression of disease. Studies show that lunate core decompression has good long-term (five-year) results for the majority of patients. Occasionally, tenderness over the lunate persists but the majority of pain and disability are gone. Some patients do end up needing further surgery if the lunate fails to recover. Ask your surgeon if you qualify for a core decompression procedure. It may be something that would work for you. Saeed Mehrpour, MD, et al. Treatment of Kienböck Disease by Lunate Core Decompression.In The Journal of Hand Surgery. October 2011. Vol. 36-A. No. 10. Pp. 1675-1677.

*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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