Avascular Necrosis of the Lunate.
Edited By: Thomas Trumble, M.D.
Last updated Thursday, March 17, 2005
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Symptoms
Anatomy
Kienbock’s is avascular necrosis of the lunate which
is one of the eight bones that make up the carpus. The carpus consists of two rows of four small
bones that lie directly distal to the wrist joint. In fact, the proximal row of the carpus forms
part of the wrist, or radiocarpal joint.
The lunate is a central bone of the radiocarpal joint. It articulates
directly with the distal radius. It has
key ligamentous attachments that stabilize the rest of the carpus. When it collapses, the biomechanics of the
wrist are altered in such a way that causes sequential degenerative changes
throughout the radiocarpal and intercarpal joints. Initial symptoms
Earliest symptom is central dorsal wrist pain that is
aggravated by loading maneouvres such as compression in wrist extension (eg
push-up position). Symptoms
Initially patients will report
central dorsal wrist pain that radiates up the forearm with associated
stiffness, tenderness, and swelling over the lunate.
Passive dorsiflexion of middle
finger may produce characteristic pain.
As the condition progresses,
patients will note a limitation of wrist motion (usually extension), and
weakness of grip.
As the lunate collapses and
degenerative changes develop the pain, weakness, and stiffness will increase
causing severe and chronic disability.
Progression
Initially patients will report
central dorsal wrist pain that radiates up the forearm with associated
stiffness, tenderness, and swelling over the lunate.
Passive dorsiflexion of middle
finger may produce characteristic pain.
As the condition progresses,
patients will note a limitation of wrist motion (usually extension), and
weakness of grip.
As the lunate collapses and
degenerative changes develop the pain, weakness, and stiffness will increase
causing severe and chronic disability.
Secondary effects
There are no systemic effects of Kienbock’s. All the symptoms are directly related to
collapse of the lunate and spread of arthritis through the carpus.Conditions with similar symptoms
There are numerous conditions that can cause central
dorsal wrist pain. These may originate
from the subcutaneous tissues (tumors, neuromas), extensor tendons
(tenosynovitis), joint capsule (dorsal wrist ganglion), ligaments (scapholunate
tears, SLAC wrist, SNAC wrist), and joint (arthritis).
Accurate
diagnosis requires thorough history, physical examination, investigations,
follow-up, and vigilance for the condition.
Surgery for Kienbock's Disease at the University of Washington, Department of Orthopaedics and Sports Medicine, Seattle, Washington
If you are interested in making an appointment to discuss this procedure in Seattle, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-BONE (2663) to make an appointment. Our clinical center is located in Seattle Washington, USADisclaimer
This resource has been provided by the University of Washington Department of Orthopaedics and Sports Medicine as general information only. This information may not apply to a specific patient. Additional information may be found at http://www.orthop.washington.edu or by contacting the UW Department of Orthopaedics and Sports Medicine.
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