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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
July 26, 04:22 AM

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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
James Fernau
James Fernau, MD
Plastic Surgeon in Pittsburgh, PA
Level: Master Contributor (64)
Website: James Fernau, MD
July 30, 09:34 PM
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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
Greg M. Balourdas
Greg M. Balourdas, MD
Hand Surgeon in San Diego, CA
Level: Contributor (12)
July 26, 07:27 AM
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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!
Jason Hess
Jason Hess, MD, FACS
Plastic Surgery in San Diego, CA
Level: Key Opinion Leader (100)
Website: Jason Hess Plastic Surgery Inc.
March 24, 12:03 AM
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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
R. Brian Williams, DO
Orthopedic Surgeon in Palm Harbor, FL
Level: Contributor (19)
August 29, 02:35 AM
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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.
Brooke R. Seckel
Brooke R. Seckel, MD
Plastic Surgeon in Boston, MA
Level: Top Contributor (28)
Website: Dr. Brooke Seckel
September 14, 02:03 PM
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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
Gregory Fedorcik, MD
Hand Surgeon in Eatontown, NJ
Level: Candidate (2)
Website: https://centraljerseyhand.com
July 27, 09:12 PM
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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
Tracy E. McCall, MD
Plastic Surgeon in Pewaukee, WI
Level: Master Contributor (77)
Website: http://wiplasticsurgery.com
July 27, 01:16 AM
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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.
Growing Medical Marijuana Card Doctor
Growing Medical Marijuana Card Doctor, MD
Medical Marijuana in Los Angeles, CA
Level: Key Opinion Leader (100)
Website: Growing Medical Marijuana Card Doctor
November 02, 03:57 PM
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Imaging is needed, CT or MRI, with follow up assessment by your surgeon. Difficult problem overall
Brian Bansidhar
Brian Bansidhar, DO
Colon & Rectal Surgery in Erie, PA
Level: Contributor (5)
September 11, 04:19 AM
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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
Gordon D. Lutchman, MD
Vascular Surgeon in Staten Island, NY
Level: Candidate (1)
July 31, 03:14 AM
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