Kienböck's Disease Info
Last reviewed
Kienböck’s disease — progressive wrist pain from lunate avascular necrosis; diagnosis and treatment options.
What you're feeling
Kienböck’s disease often starts as a vague, dull ache on the top of your wrist, near the base of your middle finger. You might notice the pain worsens when you push up from a chair, lift groceries, or grip a steering wheel. Many people mistake these early symptoms for a simple sprain or overuse injury, so they often ignore them for months.
As the condition progresses, the pain becomes more constant and sharper. You may feel a grinding sensation or hear clicking sounds when you move your wrist. Swelling is common, and you might find it difficult to make a full fist or rotate your hand, such as when turning a doorknob. The discomfort can radiate up your forearm, making everyday tasks feel increasingly frustrating and limiting.
What's actually happening
Your wrist is made of eight small bones called carpals. The lunate is one of these central bones, sitting in the middle of the proximal row. It relies on a delicate network of blood vessels to stay healthy. In Kienböck’s disease, this blood supply is interrupted, causing the lunate bone to lose its vitality. This process is known as avascular necrosis, or osteonecrosis.
Without adequate blood flow, the bone tissue begins to die and weaken. Over time, the lunate can collapse or fracture under the normal stresses of daily life. This collapse changes how the other wrist bones move and share weight. The misalignment puts extra pressure on surrounding joints, leading to secondary arthritis and stiffness.
Several factors can contribute to this loss of blood flow. One common anatomical factor is "negative ulnar variance," where the ulna bone (the bone on your pinky side) is slightly shorter than the radius bone on your thumb side. This structural difference can increase the mechanical load on the lunate, making it more susceptible to injury. Repetitive trauma or a single significant injury, like a fall, can also damage the blood vessels. In some cases, the cause remains unknown, but the result is the same: a weakening bone that struggles to support your wrist.
What we can do about it
Treatment depends heavily on the stage of the disease, which is determined by how much the lunate has collapsed and whether arthritis has developed. Your surgeon will discuss options ranging from rest to complex reconstruction.
For early-stage disease, where the bone is weakened but not yet collapsed, the goal is to relieve pressure and encourage healing. Your surgeon might recommend immobilizing the wrist in a cast or splint to reduce stress on the bone. If this does not help, surgical options may include a radial osteotomy. This procedure involves cutting and shortening the radius bone to shift weight away from the lunate. Another option is vascularized bone grafting, where healthy bone with its own blood supply is transplanted to the lunate to promote revascularization. These procedures aim to preserve your natural wrist joint and prevent further collapse.
In later stages, when the lunate has collapsed or arthritis has set in, the focus shifts to pain relief and maintaining function. If the collapse is limited, your surgeon might perform a partial wrist fusion (arthrodesis) to stabilize the painful joints while preserving some motion. For more advanced disease, a proximal row carpectomy may be recommended. This surgery removes the three collapsed bones in the proximal row, allowing the capitate bone to articulate directly with the radius. This can provide good pain relief and functional motion.
In the most severe cases, where arthritis has spread across the entire wrist, a total wrist fusion may be necessary. This procedure eliminates all motion in the wrist joint, which guarantees pain relief but results in a stiff wrist. Your surgeon will tailor the approach to your specific anatomy, activity level, and pain severity.
When to see someone
You should consult a clinician if you experience persistent wrist pain that does not improve with rest or over-the-counter pain relievers after a few weeks. Seek evaluation if you notice swelling, stiffness, or a noticeable change in the shape of your wrist. It is also important to see a specialist if you experience weakness in your grip or if the pain begins to interfere with your daily activities, such as dressing, cooking, or working. Early diagnosis can help preserve wrist function and prevent irreversible damage.
