Kienbock's Disease: 101

While I was home thinking about surgery and making plans, I did some research on my condition.

Kienbock's Disease was only discovered in 1910 by an Austrian Dr. Robert Kienbock. He was a radiologist who was a pioneer in x-ray technology. He thought, originally, that Kienbock's was a result of malnutrition and tears in the ligaments and blood vessels.

Kienbock's Disease has no known cause, even today. There are many conjectures over what could possibly be the cause, and the two most viable conclusions are: a pre-disposition or a direct physical trauma such as falling on your hand (his includes repeated physical traumas). Because the lunate is so small and in an awkward position, it is rather difficult to cause the bone to collapse or fracture so these are the most widely accepted causes of the disease. In fact, less than 0.05% of the population has, or will have this disease.

In my particular case, the likely cause was a predisposition for my radius to grow abnormally long, and because I had two accidents in a very short time period (one a football accident, one a car accident) this could have cause the trauma that fractured and collapsed the lunate. This is according to Dr. P. my specialist, and Dr. R.'s contact at Landstuhl's orthopedic clinic.


The progression of the disease has 5 stages I, II, III-A, III-B and IV. There are many definitions of each stage; no one has a universal set explanation. My stage has been identified as III-A. This is the stage where the lunate is dead, it has collapsed, but I have not yet developed arthritis from the bone disintegration/movement/upset. In my stage, there is dramatically limited motion and range in the hand and wrist.

Typically, Kienbock's develops in young persons. Most people are in their 20s when it is discovered, but the typical age range is 20-40. More often than not, Kienbock's Disease affects the dominant hand. There are rare cases where it affects both as well. Mostly, people who have Keinbock's are predominantly men.

Some people will have a positive or negative ulnar or radial difference (meaning the bone is longer or shorter than it should be). This causes the bones in the wrist and hand to be disrupted. So, Less than 1/2% of people have Kienbock's Disease, and I am an even smaller percentage who has a variable bone size in my arm. This makes my disease state somewhat unusual, but not uncommon in Kienbock's.

Most doctors have never heard of Kienbock's disease - even in orthopedics. Mostly, a specialist in hands will be the only ones aware of the disease. While taking physical therapy, I worked with 3 certified hand therapists. Two had heard of the disease, and only one had ever worked with a patient with Kienbock's before, just one person in their entire career had ever had the disease. Additionally, they all had to conduct extensive research on the under documented disease in order to know how to treat my condition.

Symptoms of Kienbock's Disease are wide and varied, and commonly mistaken for other conditions. A few of the most widely reported symptoms are:

wrist pain
wrist swelling
tenderness
intense stabbing/crushing/throbbing pain
pain and difficulty moving the wrist in any and all directions
inability to use hand normally
stiffness
broken or fractured bones
arthritis
bone movement
bone collapse
bone disintegration
clicking in wrist or hand with movement
chronic pain in middle finger, or between the middle and ring finger
weakness in wrist, hand, grip, movement
inability to sleep due to discomfort or pain
inability to do simple/sedentary actions


If you have questions directly related to Kienbock's Disease, please feel free to ask. I will answer to the best of my ability.