Kienböck’s Disease: Diagnosis, Treatment, and Rehabilitation at Palms Physiotherapy & Allied Health

What is Kienböck’s Disease?

Kienböck’s disease is a condition where the lunate bone in the wrist undergoes progressive bone degeneration due to the loss of blood supply. This leads to avascular necrosis, where the bone tissue dies and loses its structural integrity. Over time, this can cause pain, deformity, and loss of movement in the wrist, affecting both daily activities and sports performance.

The condition is most commonly seen in young to middle-aged adults, especially those between the ages of 20 and 40. The exact cause of Kienböck’s disease is still not fully understood, though several factors may contribute to its development, including trauma, repetitive stress, and anatomical variations in the wrist.

Symptoms of Kienböck’s Disease

The symptoms of Kienböck’s disease develop gradually and may vary depending on the stage of the disease. Common symptoms include:

1. Pain

• Pain in the wrist, particularly on the dorsal side (back of the wrist) and around the lunate bone.

• The pain may worsen with activities that involve gripping, twisting, or weight-bearing, such as lifting objects, typing, or playing sports.

2. Stiffness

• Reduced range of motion in the wrist joint, especially when trying to bend or extend the wrist.

• Difficulty performing tasks that require wrist mobility, such as turning a doorknob or reaching overhead.

3. Swelling

• Swelling and tenderness around the wrist joint, particularly near the lunate bone.

• In some cases, the wrist may appear visibly deformed as the disease progresses.

4. Weakness

• Weakness in the wrist, making it harder to hold objects or perform tasks that require strength and dexterity.

5. Clicking or Popping Sensation

• A sensation of clicking, popping, or grinding may occur when moving the wrist. This is typically caused by the irregular bone surface in the lunate as it deteriorates.

Causes of Kienböck’s Disease

The precise cause of Kienböck’s disease is not well understood, but it is believed to be associated with several potential factors:

1. Trauma or Injury

• A traumatic injury or repetitive microtrauma to the wrist, such as from falls or high-impact sports, may disrupt the blood supply to the lunate bone, triggering the disease.

• In some cases, even a seemingly minor injury or repetitive stress over time can lead to the development of Kienböck’s disease.

2. Anatomical Factors

• Anatomical variations, such as a shortened radius (the bone on the thumb side of the forearm), can contribute to increased pressure on the lunate bone and a compromised blood supply, leading to the disease.

3. Vascular Issues

• Vascular insufficiency or problems with blood circulation to the lunate bone can cause the bone to die over time. This can happen due to narrowed or blocked blood vessels, affecting the delivery of oxygen and nutrients to the bone.

4. Genetic Factors

• Some studies suggest that genetic predispositions may play a role in the development of Kienböck’s disease, although this is not yet fully established.

Stages of Kienböck’s Disease

Kienböck’s disease is typically classified into four stages based on the degree of bone damage and the progression of the condition:

• Stage 1: The lunate bone shows signs of early vascular compromise, but there is no significant bone damage visible on imaging. Symptoms may be mild.

• Stage 2: The lunate bone begins to show structural changes and may appear slightly collapsed or deformed on imaging. Pain and stiffness become more pronounced.

• Stage 3: Significant bone degeneration occurs, with noticeable collapse of the lunate bone. The wrist may become stiff and less functional.

• Stage 4: The lunate bone has undergone significant necrosis and collapse, and the wrist joint may show signs of osteoarthritis. Pain is often constant and can be severe.

Diagnosis of Kienböck’s Disease

The diagnosis of Kienböck’s disease generally involves a comprehensive evaluation, including:

1. Physical Examination

• A thorough physical exam to assess pain, swelling, range of motion, and strength of the wrist.

• Specific tests may be conducted to check for signs of tenderness or instability in the wrist joint.

2. Imaging Tests

• X-rays: Standard X-rays can help detect changes in the lunate bone, including collapse or flattening, indicative of Kienböck’s disease.

• MRI: Magnetic Resonance Imaging (MRI) provides detailed images of the soft tissues and bone structures and is particularly helpful in identifying early-stage bone damage or avascular necrosis.

• CT scan: In some cases, a CT scan may be used to evaluate the extent of bone collapse and the involvement of the wrist joint.

Treatment Options for Kienböck’s Disease at Palms Physiotherapy & Allied Health

At Palms Physiotherapy & Allied Health, we provide a holistic treatment approach for Kienböck’s disease, focused on pain management, restoring wrist function, and preventing further joint degeneration.

1. Rest and Activity Modification

• Rest is often recommended to reduce the stress on the affected wrist and prevent further damage. Modifying daily activities to avoid repetitive motion or high-impact tasks can help alleviate pain and protect the wrist during recovery.

2. Ice Therapy

• Ice packs applied to the wrist can reduce inflammation and swelling, particularly in the early stages of the disease.

3. Physiotherapy and Exercise Rehabilitation

• Physiotherapy plays a critical role in the recovery process. Through targeted stretching, strengthening, and mobilization exercises, we help restore wrist function and improve the range of motion.

• Our expert physiotherapists will design a customized rehabilitation plan to improve wrist mobility, reduce stiffness, and strengthen the surrounding muscles for better joint support.

4. Splinting or Bracing

• A wrist splint or brace may be used to provide support and immobilize the wrist, particularly during the early stages or acute pain periods.

5. Anti-Inflammatory Medications

• NSAIDs (non-steroidal anti-inflammatory drugs) can be used to manage pain and inflammation associated with Kienböck’s disease.

6. Corticosteroid Injections

• For persistent pain, corticosteroid injections may be considered to reduce inflammation and provide longer-lasting relief.

7. Surgical Intervention

• In advanced stages of Kienböck’s disease, surgical intervention may be required. Possible procedures include:

  • Wrist fusion or proximal row carpectomy to reduce pain and improve function.

  • Bone grafting or vascularized bone graft procedures may be used to restore blood supply to the lunate bone.

  • Joint replacement may be considered if the disease progresses to severe stages.

Recovery and Rehabilitation

Recovery from Kienböck’s disease requires a combination of rest, rehabilitation, and, in some cases, surgical intervention. Our rehabilitation programs at Palms Physiotherapy & Allied Health aim to restore full wrist function and reduce the risk of long-term disability. Rehabilitation typically involves:

• Early Stage: Pain management, splinting, and rest.

• Intermediate Stage: Gradual mobility exercises and strengthening routines to regain wrist flexibility.

• Advanced Stage: Focus on functional rehabilitation to allow for the return of daily activities and sports.

Conclusion

Kienböck’s disease can significantly affect the quality of life, but with early diagnosis and comprehensive treatment, the impact can be minimized. At Palms Physiotherapy & Allied Health, our multidisciplinary team is dedicated to helping you manage the symptoms, improve wrist function, and support your recovery. If you are experiencing wrist pain or suspect Kienböck’s disease, please contact us today for an assessment and personalized treatment plan.

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