My husband was recently diagnosed with KienbÃ¶ck's disease. He makes a living as a piano professor at our local university. What will happen to his wrist with this disease?
The wrist is made of eight separate small bones, called the carpal bones. There are two rows of carpal bones that connect the two bones of the forearm, the radius and the ulna, to the bones of the hand.
Kienbock's disease is a condition in which the lunate bone loses its blood supply and dies, causing pain and stiffness with wrist motion. The lunate is one of the bones in the proximal row of carpal (wrist) bones. That's the row of bones closest to the radius and ulna (bones of the forearm).
In the late stages of the disease, the lunate collapses, shifting the position of other bones in the wrist. This shifting eventually leads to degenerative changes and osteoarthritis in the joint.
How long the patient has before these changes take place is unpredictable. It seems to differ from patient to patient without apparent cause. Treatment ranges from conservative (nonoperative) care to a variety of surgical options.
The goal of treatment is to decrease the load across the lunate and/or bring a better blood supply to it. Treatment is determined by what stage the disease is in. Staging can be difficult since the degenerative changes occur slowly over a long period of time. Repeated imaging studies may be needed to confirm earlier suspicious findings.
There is no strong evidence at this time to suggest one treatment works better than another. The physician looks at all the factors and makes the best clinical judgment possible. The patient's age, occupation, activity level, and findings from the diagnostic process will all be taken into consideration.
Alexander S. Croog, MD, and Peter J. Stern, MD. Proximal Row Carpectomy for Advanced KienbÃ¶ck's Disease: Average 10-Year Follow-Up. In The Journal of Hand Surgery. September 2008. Vol. 33A. No. 7. Pp. 1122-1130.
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