Overview
what it is and why it mattersKienbock's disease is what happens when the small lunate bone in the center of your wrist loses its blood supply (a process called avascular necrosis). Without blood, the bone gradually collapses and fragments. The exact cause isn't fully understood — a combination of injury, an anatomic variation in the length of one forearm bone relative to the other, and the way blood vessels enter that bone all seem to contribute. It most often affects young men in their 20s through 40s, and almost always in their dominant hand.
Early on, patients have pain on the back of the wrist and a weaker grip — but X-rays look normal. Later, X-rays show the lunate flattened or fragmented, with arthritis spreading to the surrounding wrist joints.
Symptoms
what you may noticeThe earliest symptom is a dull, aching pain on the back of your wrist, centered over the lunate — roughly in the middle of the wrist crease. Pain worsens when you push off with your hand (such as getting up from a chair) or grip firmly. Grip strength drops noticeably compared to your other hand.
Swelling on the back of the wrist is common, and wrist motion — especially bending backward — gradually becomes limited. In later stages the wrist may feel stiff most of the time, and you may notice a clicking sensation when you move it. Because early symptoms mimic a simple wrist sprain, many patients go months before seeking evaluation.
Diagnosis
exam first, imaging secondPlain X-rays look normal in stage I, which is why the diagnosis is often missed early. MRI is the most sensitive early test — it shows the bone's lost blood supply long before the bone has visibly changed. CT is added once fragmentation is suspected. The disease is staged 1 through 4 (the Lichtman classification), and each stage has different treatment options.
Treatment Path
how care progresses at OSI1
Immobilization
For early-stage disease (Lichtman 1 to 2), a wrist cast can sometimes give the bone a chance to revascularize on its own — most useful in younger patients caught early.
Surgical Options at OSI
if non-operative care isn't enoughMost cases beyond stage 1 benefit from surgery to halt the progression. The specific operation depends on the stage — options range from procedures that take pressure off the lunate (joint-leveling osteotomies) to fusing or removing affected bones in advanced disease.
Providers Who Treat Kienbock's Disease
sports-medicine team
Further Reading
authoritative sourcesExternal patient-education references and related OSI pages for additional background: