All paid DoctorBase customers will be migrated to Kareo Marketing on December 15, 2016. Read how to get your practice ready for the transition.
×

4 Reasons Why Ask DoctorBase is the Most Efficient Way to SEO and Establish Your Brand Online

  1. Ask DoctorBase is a free service for patients on the DoctorBase platform - currently servicing over 6 million American patients of record.
  2. All answers submitted by healthcare professionals (you) are for entertainment purposes only and do not constitute doctor-patient relationships. All patients must agree to this before using Ask DoctorBase.
  3. Our software and our Marketing Engineering staff review each answer and optimize your answers for keywords valuable to your specialty. It is a well kept secret that doctors (you) - not SEO consultants - are the ones who have the most valuable content prized by search engines. Ask DoctorBase "unlocks and optimizes" your content in the most efficient manner possible with today's technology.
  4. Finally, the doctor who provides the most popular answer - "the Featured Answer," gets an added benefit by allowing patients to write rave reviews about your expertise - reviews that are submitted to both Google and Google Local through our Preferred Data Provider relationship.

Ask Dr. Molly if you have questions or want a personal session on how to best use Ask DoctorBase for maximum marketing impact.

...

Molly Maloof, MD

Director of Clinical Content
@DoctorBase

Kienbock's Disease

Hello -

about a year and half ago I had a capitate shortening and revascularization done in my right wrist to treat Kienbock's disease. I am now 18 years old and a year and a half later I am having some pain in the same wrist. What would be a guess as to what happened? and What a doctor would do next to treat this?
Poster
  • Male | 18 years old
  • Complaint duration: 15 days
  • Conditions: Kienbock's Disease

Find low drug prices at local & online pharmacies

Find low drug prices at local & online pharmacies

Featured Answer

3 UpVoted this answer
Residual pain in the wrist after any wrist surgery is not uncommon. If the pain becomes excruciating the radius may be putting to much pressure on the lunate and the radius may need to be shortened by 2-5 mm. If the pain continues and you reach stage 3 the lunate begins to break apart from the surrounding pressure of the other wrist bones producing sharp fragments of floating bone which becomes excruciatingly painful. Treatment may require a proximal row carpectomy which involves removing the lunate and the scaphoid and the triquetrum. This diminishes wrist motion and relieves the wrist pain. Make sure you see a board certified hand surgeon . Good luck
3 UpVoted this answer Gabriel Goren, MD Vein Treatment Specialist / General Surgeon, Encino
Hello,

Kienbock's (avascular necorsis of the lunate) can have long-term consequences for your wrist. Depending on the stage of collapse of your lunate at the time of your previous surgery, and although capitate shortening can be very effective, you may be experiencing progression of lunate collapse. Ultimately, even if the right procedure is done, the relationship between the bones can change and arthritis can develop.

You need to get in to see your surgeon for repeat x-rays and possibly other imaging. What is then recommended depends on those findings. Treatment could splinting, anti inflammatories but also might include further surgery to decompress the lunate and improve circulation. It is unlikely that arthritis has progressed this quickly but joint fusion is sometimes a salvage option. Hope that helps.

Greg Balourdas, MD

TheHandDoctor.com
2 UpVoted this answer
Kienbock's Disease is a difficult disorder to treat. The natural history, when left untreated, is for this ailment to evolve into wrist arthritis.

As you may know, Kienböck's disease is a condition where the blood supply to one of the small bones in the wrist, the lunate, is interrupted.

Bonerequires a regular supply of blood. If the blood supply is disrupted, osteonecrosis, or dead bone can result.

Damage to the lunate causes a painful, stiff wrist and, over time, can lead to arthritis.

Depending upon the stage of the disease, various surgical options are mandated. Revascularization is a complex procedure; It is conceivable that revascularization failed to completely treat the problem or the symptoms. When all else fails, a proximal row carpectomy or wrist fusion will cure pain, but will obviously destroy wrist mobility.

These are invasive procedures and are avoided unless less invasive options are available.

Further imaging is necessary here including a possible CT angiogram or MRI. I hope this helps!
2 UpVoted this answer
Dr. Balourdas gave a very nice description. He is absolutely correct and I echo his response. Get back in to see someone as soon as you can.
R. Brian Williams
1 UpVoted this answer
Thank you for your question. I am very sorry to hear of the difficulty that you are having. There are several possibilities as to what is causing your new pain. Progressive arthritis or recurrent vascular necrosis are both potential problems. You need a diagnostic evaluation with an MRI possibly contrast-enhanced. You need a consultation with an excellent board certified plastic or orthopedic surgeon was special fellowship training in hand surgery. Preferably a surgeon who also performs microvascular surgery and is experienced at revascularization. Good luck.
1 UpVoted this answer
Hello and thanks for your question.

Kienbock's disease can be a difficult condition to treat depending on the stage of disease. Without knowing what stage you had and what type of revascularization you had done it is very difficult to determine what if anything went wrong. The next step would certainly be a comprehensive physical exam and imaging with x-ray and most likely MRI to evaluate the lunate for collapse and vasculality.
Gregory Fedorcik
1 UpVoted this answer
Kienbock's disease is a difficult condition to treat, and you are young. It has been said that when there are multiple treatments for something, no one treatment works best/exceptionally. This is true of Kienbock's. You should get a re-evaluation. You may want to present back to your original surgeon, or you may want to get a second opinion, or you may choose to do both. Please understand that this is likely something that you will be dealing with again at some point in the future. Repeat imaging is quite possibly indicated, along with a good exam. Remember that there is more than one cause of wrist pain, and that this may be the case here.
Tracy E. McCall
Start doing hand exercises 4 times weekly. I recommend a bucket of uncooked rice and doing letters of the alphabet with a closed fist inside the rice. You should also think about myofascial release massage.
Imaging is needed, CT or MRI, with follow up assessment by your surgeon. Difficult problem overall
I apologize- this is not my area of expertise. I would suggest to see a reputable hand surgeon in your area, with all your Xrays and imaging studies as well as a copy of your operative report.
Gordon D. Lutchman