Kienbock’s disease

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Kienbock’s disease

  1. 1. KIENBOCK’S DISEASE
  2. 2. Introduction  Form of ischemic necrosis that usually follows chronic stress or injury.  Has been suggested that relative shortening of the ulna predisposes to stress overload of the lunate between the distal edge of the radius and the carpus.
  3. 3. Pathology  Four stages:  Stage I- ischaemia without naked eye or radiographic abnormality.  Stage II-trabecular necrosis with reactive new bone formation and increased radiographic density, but little or no distortion of shape.  Stage III- collapse of the bone.  Stage IV- disruption of radio-carpal congruence and secondary OA.
  4. 4. Clinical Features  Young adult  Ache and stiffness  Occasionally h/o acute trauma.  Tenderness localized over the lunate.  Grip strength is diminished.  Later stages- wrist movements are limited and painful.
  5. 5. Imaging  X-ray: no abnormality(in initial stages).  Later may show either mottled or diffuse density of the bone.  Stage 3- bone looks squashed and irregular.  Stage 4- osteoarthritic changes in wrist.  Radioscintigraphy- increased activity.  MRI- most reliable way of detecting early changes.  Ulnar variance- assessed by standardized x-ray examination with the shoulder abducted to 90, forearm in neutral rotation and the wrist in neutral flexion- extension.
  6. 6. TREATMENT
  7. 7. Non operative  Early cases- splintage of the wrist for 6-12 weeks.  Relieves pain and reduces mechanical stress.  If bone healing catches up with ischemia, lunate may remain virtually undistorted.
  8. 8. Operative treatment  If the wrist architecture is only minimally disturbed(i.e up to early stage 3)-reduction of carpal stress by shortening the radius.  Once bone is collapsed-options are limited.  Lunate replacement by silicone prosthesis- poor long term results and is liable to cause synovitis.  Intercarpal fusion or excision of proximal row of carpus-improves function.
  9. 9.  If pain and restriction of movement become intolerable: radio-carpal arthodesis.
  10. 10. THANK YOU

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