Avascular Necrosis of the Lunate.
Edited By: Thomas Trumble, M.D.
Last updated Thursday, March 17, 2005
Prognosis and impactsPrognosis Once it is determined that the lunate has sustained a
vascular insult, immediate intervention is warranted. The condition follows a predictable pattern
of arthritic degeneration which leads to progressive and debilitating pain with
loss of function. In the rare instance
the lunate may spontaneously
revascularize before the onset of arthritis; however, this should not be
hoped for and treatment should not be delayed.Lethality The symptoms are limited to the affected wrist. There are no systemic manifestations of
Kienbock’s disease and it is not fatal.Pain One of the earliest manifestations of Kienbock’s is
mid-dorsal wrist pain. As the arthritis
spreads, the pain increases and becomes more diffuse. It is aggravated by any activities that cause
compression loading of the wrist, particularly with extension. Debilitation The pain eventually becomes debilitating as the
arthritis spreads to involve the whole wrist.
Patients will experience not only pain with activities but also at
rest. It will interfere with the ability
to perform even sedentary work and often wakes them from sleep. Increased dependency on analgesics is common.Comfort The pain eventually becomes debilitating as the
arthritis spreads to involve the whole wrist.
Patients will experience not only pain with activities but also at
rest. It will interfere with the ability
to perform even sedentary work and often wakes them from sleep. Increased dependency on analgesics is common.Curability If diagnosed early, interventions can unload the lunate
and potentially allow for revascularization.
The choice of treatment is determined by the anatomy of the individual
(ulnar variance) and the stage of disease.
Once
the arthritis becomes more widespread, only salvage procedures can be
attempted. These typically involve a
series of bony fusions or resections directed at ablating arthritic
joints. This alleviates the pain but
also results in decreased motion and strength. Fertility and pregnancy Kienbock's disease will not change the patient's ability to have children or get pregnant.Independence The progressive and debilitating nature of Kienbocks
disease often interferes with a person’s independence. The pain and loss of use of the affected
extremity often affects vocation, recreation, and activities of daily living
(personal hygiene, cooking, cleaning, ability to dress, etc.)Mobility Kienbock's disease will not change the patient's ability to move about.Daily activities The pain tends to be aggravated by activities that
load the wrist. Initially this may only
interfere with heavy labor or sports but as the arthritis progresses, it
typically will limit basic activities of daily living. Eventually the pain will be present even with
inactivity and will wake patients regularly at night.Energy Fatigue may result from lack of restful sleep and the
stress of chronic pain. Otherwise,
kienbock’s does not have any systemic manifestations and will not affect a
patient’s metabolism.Diet Kienbock's disease will not require a change in diet.Relationships The effects of chronic pain, loss of work,
restrictions in recreational pursuits,
and loss of sleep will strain relationships both at work and home. Other impacts The condition is not contagious and does not spread to
other joints in the body. The
restrictions and limitations are associated with the loss of use of the
extremity. This may be secondary to the
pain or as a consequence of surgical interventions directed at treating the
pain.Surgery for Kienbock's Disease at the University of Washington If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-4537 to make an appointment.
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