Do You Have a Wrist Sprain, Carpal Tunnel, or Kienböck’s Disease?

The wrists are the workhorses of the upper body. They rarely get any rest between mindless motions like buttoning shirts and major impacts like breaking a fall. Persistent pain could be a sign of chronic overuse or a small injury getting worse. Or, at the top of the wrist, it could point toward a rare condition called Kienböck’s disease.

Kienböck’s disease develops when the primary bone in the wrist (the lunate bone) doesn’t receive enough blood flow. The bone gradually becomes brittle and collapses, causing pain, swelling, and a limited range of motion. It might feel like a sprain. Kienböck’s disease is also called avascular necrosis of the lunate bone and lunatomalacia.  This progressive wrist disease typically affects about 200,000 adults (.005% of the U.S. population) between the ages of 20 and 40 each year. Keep reading to learn about the causes of Kienböck’s disease pain, treatment options, and the outlook for those suffering.

Signs of Kienböck’s Disease

This wrist disease is a progressive condition that gradually gets worse.

The Disease Stages of Wrist Bone Avascular Necrosis

For patients with Kienbock’s disease, their wrists deteriorate slowly through four stages.

• Stage 1: The bone loses blood flow, which may or may not hurt.
• Stage 2: The bone starts to harden and mild symptoms surface.
• Stage 3: The hardened bone breaks off and may dislocate, causing worse pain and limited motion. 
• Stage 4: The bone completely collapses and damages surrounding parts of the wrist, potentially causing arthritis.  

Common Symptoms

• Wrist pain
• Wrist tenderness
• Wrist stiffness
• Wrist swelling
• Limited wrist movement
• Decreased grip strength

Some cases of Kienbock’s disease start off asymptomatic. Once pain becomes noticeable, it’s usually on top of the wrist, right in the middle. 

How quickly you pick up on pain caused by this disease might depend on whether it’s caused by an injury or accident you can remember, or a condition you don’t even know you have.

What Causes Kienböck’s Disease?

Keinböck’s disease can develop through everyday wear and tear, a trauma event or impact, related health conditions, or one’s natural bone structure. There is no evidence that it’s genetic, but hereditary factors can make it more likely to develop this wrist disease. Most cases are a result of one or both of these factors:

• Reduced blood flow to the lunate bone: A number of issues can affect the wrist’s blood circulation.
• Wrist bone structure or alignment differences: You can be born with bone structure that causes Kienböck’s disease or develop it over time. 

Reduced Blood Flow to the Wrist’s Lunate Bone

Most cases of Kienböck’s disease start with an interruption of blood flow to the lunate bone in the wrist. Here are the four common causes of circulation issues that lead to it. 

Trauma or Injury

A blunt-force injury to the wrist is a risk any time you fall, have a car accident, play sports, or collide with another person or object. The wrist is under pressure whenever you’re pushing on your hands while they’re flexing. Too much stress can damage the blood vessels that supply the wrist with blood flow, decreasing blood flow. 

Overuse

Your wrists can simply wear out from repetitive everyday motions, like using a phone or swinging a golf club. 

Employees working in several industries are susceptible to wrist overuse injuries, such as:

• Administrative/Clerical
  • Examples: Any position  requiring heavy computer use
• Service
  • Example: Grocery cashiers (swiping) and deli counter workers (slicing)
• Factory
  • Example: Assembly line workers
• Construction
  • Examples: Jackhammer operators and power saw users

Playing some sports (that involve regular gripping and swinging) may also repeatedly stress the wrist and cause Kienböck’s disease, such as:

• Golf
• Tennis
• Pickleball
• Other racquet sports
• Gymnastics
• Weightlifting

Hobbies—such as needlepoint crafts, beading, video gaming, using mobile apps, and playing some musical instruments—may also interrupt blood flow to the wrist’s lunate bone.

Health Conditions and Lifestyle Factors

Certain medical conditions, medications, lifestyle choices, and hobbies can shrink the blood vessels and reduce circulation to the lunate bone, increasing the risk of Kienböck’s disease. These include:

• Medical conditions (like lupus, sickle cell disease, clotting problems)
• Medications (such as steroids, including cortisone, hydrocortisone, prednisone)
• Lifestyle choices (like smoking, drinking, poor diet, sedentary living)

Wrist Bone Structure and Alignment Differences

Your anatomy might increase your risk of damage to the lunate bone, the root of Kienböck’s disease pain. For instance, if the forearm’s ulna bone is shorter than the radius, it can affect the wrist mechanics. Other variations in bone shape and size can throw off normal alignment. These differences can be hereditary or developmental. Both occurrences might stress the lunate bone when you move the wrist, or pinch it and cut off circulation, causing gradual bone deterioration.   

Can Kienböck’s Disease Be Prevented?

In some cases, when avascular necrosis of the lunate bone is caused by chronic overuse, it can be prevented. If you’re at risk for an overuse injury, you should strengthen your wrists, rest them regularly, and treat soreness and tightness as soon as they occur. 

Other cases are out of your control. Risk factors associated with anatomical variances or an unrelated illness that affects circulation are hard to catch. The onset of Kienböck’s disease is difficult to detect because it can be asymptomatic in the early stages. If you don’t know you’re at risk, you can’t take steps to prevent it. 

However, an expert in wrist care can prevent Kienböck’s disease from progressing to advanced stages if diagnosed early and treated properly. A full collapse of the bone usually takes three to five years, leaving ample time to prevent the worst-case scenario.

If you’re experiencing any symptoms or have had an accident involving the wrists, consult a physician immediately. You’ll greatly increase the chance of catching the risk factors associated with Kienböck’s disease before it develops or progresses to a severe case.

Diagnosing and Treating Kienböck’s Disease

An experienced wrist specialist can determine if your wrist issues indicate avascular necrosis of the lunate bone or something else with similar symptoms, such as a wrist sprain, a fracture, or arthritis.

To make a diagnosis, the physician will review your medical history and perform a physical exam while looking to rule out the more common conditions mentioned above. An MRI may be necessary to get a better look at the lunate bone. 

If Kienböck’s disease is the diagnosis, the treatment will depend on how far it has progressed. Treatment typically involves a combination of splinting, medication, rehabilitation, and surgery.

Conservative Treatments

Mild cases of Kienböck’s disease may respond to non-invasive treatments like splinting or bracing to stabilize and immobilize the wrist, along with a cortisone shot or over-the-counter anti-inflammatory medication. If the cause is overuse or an injury, then non-surgical options can be effective through stage 2. If the cause is structural or the bone has collapsed, conservative treatments are less effective past stage 1 and may require surgery. 

Surgery

Depending on the cause and severity, several surgeries are used to treat avascular necrosis of the lunate bone, such as:

• Revascularization
• Joint leveling
• Lunate excision
• Intercarpal fusion
• Proximal row carpectomy

Revascularization

Revascularization restores blood circulation during the early stages by grafting a portion of a different bone with healthy blood vessels onto the lunate bone.

Joint Leveling

In the early or middle stages, joint leveling corrects uneven lengths of the lower arm bones by grafting a piece to lengthen the ulna or removing part to shorten the radial.

Lunate excision

A lunate excision procedure resolves Kienböck’s disease pain in advanced stages by removing all or part of the damaged lunate bone and potentially replacing it with artificial bone.

Intercarpal Fusion

During an intercarpal fusion, a wrist surgeon improves circulation and stability by joining the lunate bone to another wrist bone in advanced stages.

Proximal Row Carpectomy

If the lunate bone has collapsed and arthritis has set in, a proximal row carpectomy (PRC) procedure (in which four bones are removed) can be done to create more room for the wrist joint to move.

Post-op Rehabilitation

Whether you need occupational therapy to limit wrist motion and prevent the progression of Kienböch’s disease or regain strength and mobility after surgery, rehab, and long-term management are crucial to overcoming the condition. 

IHTSC’s comprehensive care team of specialists and therapists gives you the most options for the fastest and safest recovery possible. 

Turn to IHTSC for Expertise in Rare Wrist Conditions

Kienböck’s disease is too rare for general practitioners to diagnose and only a few orthopedic specialists have encountered it. Indiana Hand to Shoulder Center’s wrist experts have successfully treated multiple patients with avascular necrosis of the lunate bone. It’s why patients across the country trust our highly esteemed group of wrist surgeons to treat this wrist disease, as well as rare disorders, complex wrist injuries, and other difficult conditions.

If you have severe, chronic wrist pain or suspect you’ve been experiencing symptoms of Kienböck’s disease, we can help. Call IHTSC at (317) 875-9105 to book an appointment or schedule online.

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Medically reviewed by Brandon Smetana, MD