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Education · wrist

Kienböck's Disease Info In-depth Evidence

Reviewed by Dr Kieran Hirpara, Specialist Orthopaedic Surgeon Last reviewed

What you're feeling

You may notice swelling on the back of your wrist. This is a common part of the condition. The pain usually sits in the centre of your wrist. It often feels deeper than surface discomfort. You might feel stiffness when you first wake up in the morning. This stiffness can make simple movements feel tight and resistant.

Daily tasks become harder as the condition progresses. You may find it difficult to push up from a chair. Opening jars or turning doorknobs can cause sharp twinges. Lifting objects, even light ones like a kettle, may trigger pain. The discomfort often worsens after you have been using your hand for a while. Resting your wrist on a table might bring some relief. However, the pain can also flare up at night, disturbing your sleep.

The way you feel depends on the stage of the disease. In the early stages, symptoms might be mild and intermittent. You might only notice them during heavy activity. As the condition advances, the pain becomes more constant. The bones in your wrist may begin to collapse. This structural change leads to increased stiffness and reduced grip strength. You may feel a grinding sensation when you move your wrist.

It is important to understand that symptoms vary between individuals. Some people experience significant pain with minimal swelling. Others may have visible swelling but less pain. Your surgeon will look at your specific symptoms and imaging to determine the best path forward. We do not rely on symptoms alone to guide treatment. We consider the overall health of your wrist bones and joints.

If you are a teenager or young adult, your symptoms might develop differently. Younger patients often respond well to non-surgical treatments. These can help manage pain and preserve function. For older patients, non-operative care is also often the first step. We consider these options before discussing any surgical intervention. The goal is to relieve your pain and help you return to your daily activities safely.

What's actually happening

Your wrist contains a small, cube-shaped bone called the lunate. It sits in the centre of your hand and acts like a shock absorber between your forearm and your fingers. For this bone to stay healthy, it needs a steady supply of blood. However, the movements of your wrist can actually reduce blood flow to this area. When circulation drops, the bone tissue begins to weaken.

This lack of blood can lead to tiny fractures or fragmentation within the lunate. These breaks do not always line up with how much your wrist has collapsed. Sometimes the bone breaks apart early in the disease process, even before significant structural changes are visible. As the bone weakens further, it may lose its shape and height. This is known as carpal collapse. The bone essentially flattens under the pressure of daily use.

When the lunate collapses, it disrupts the smooth mechanics of your wrist joint. The bones no longer glide past each other correctly. This causes pain, stiffness, and a feeling of instability. The surrounding joints also take on extra stress, which can lead to further wear and tear over time. Understanding this process helps explain why treatments focus on either restoring blood flow in younger patients or stabilising the joint structure in advanced cases.

What we can do about it

Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, starts with the least invasive options that suit your condition. We begin by managing symptoms through self-care and therapy. You may be advised to change activities to avoid painful movements. Physiotherapy helps maintain wrist motion and strengthen surrounding muscles. For children, adolescents, and older adults, these non-surgical steps are often effective. Good outcomes are common in younger patients whose bones are still growing. We typically give this approach a fair trial before considering surgery.

Medical management focuses on reducing pain and inflammation. Your surgeon may recommend pain medication or anti-inflammatories to help you stay active. Injections can also provide relief. Cortisone injections reduce swelling and pain, though the effect is temporary. Hyaluronic acid injections aim to lubricate the joint, offering comfort for a limited period. Platelet-rich plasma (PRP) injections use your own blood components to support healing. These treatments do not reverse the underlying bone changes but can improve your daily comfort while you recover or wait for further decisions.

Surgery is considered when conservative care has not given enough improvement or if the disease is advanced. In early stages, we may use procedures like core decompression to relieve pressure or radial osteotomies to realign the wrist bones. Radial shortening osteotomy provides decade-long improvement in 75% of patients. For advanced Kienböck’s disease, where the lunate has collapsed or wear-and-tear arthritis has developed, we discuss salvage options. These include a proximal row carpectomy, which removes damaged bones to preserve motion, and a wrist fusion, which joins bones to eliminate pain. Scaphocapitate arthrodesis is another option for salvaging the wrist in advanced cases. Vascularised bone grafting may be used to restore blood supply to the lunate. The choice depends on your specific stage and goals.

Patients are generally referred to our clinic by their GP; if a physiotherapist has suggested you see us, you will still need a referral from your GP in order to be eligible for the Medicare rebate. A clinic assessment, including history, examination, and imaging such as CT or MRI, establishes the diagnosis. We then work with you to decide on the best path forward.

What to expect

Your wrist’s outlook depends largely on how far the condition has progressed. In early stages, your surgeon may recommend non-surgical options like activity changes or splinting. These approaches often provide good outcomes for children, adolescents, and older patients. You can expect reasonable long-term function if you undergo procedures like radial shortening osteotomy. This involves adjusting the radius bone to relieve pressure on the lunate.

If the disease is more advanced, with significant collapse of the lunate bone or wear-and-tear arthritis in the wrist, your treatment path changes. You may be offered joint-levelling procedures or bone grafting to preserve function. For these cases, radiographic progression over a year or more tends to be slight on average, regardless of the specific treatment chosen. However, approximately one in eight patients who have radial shortening osteotomy will eventually need salvage surgery.

Salvage options are considered when the lunate has collapsed substantially or arthritis is widespread. These include proximal row carpectomy and wrist fusion. Scaphocapitate arthrodesis is also an option. While scaphocapitate arthrodesis can alleviate pain and preserve grip strength in the long term for collapsed disease, it may yield discouraging functional outcomes in the medium term for advanced stages. Other salvage options, such as tendon ball arthroplasty, can result in long-term satisfactory clinical outcomes despite widespread changes in the wrist bones and joints.

There is no single treatment proven to be superior to all others. Some patients respond well to nonoperative care, while others benefit from surgical intervention. Your surgeon will discuss which path aligns with your specific stage of disease and lifestyle needs. The goal is to manage pain and maintain as much function as possible, recognising that outcomes vary from person to person.

When to see someone

See your GP if you have persistent wrist pain that does not improve with rest. Kienböck’s disease is a progressive condition affecting the wrist bones. You may notice swelling on the back of your hand. Ask for a specialist review if you experience weakness or instability. Locking or giving way of the wrist are also warning signs. Symptoms that interfere with sleep or work need attention. Sudden worsening of pain should be checked promptly. Early assessment helps your surgeon understand the stage of your condition. This allows for better planning of your treatment. Do not wait for symptoms to resolve on their own.

Advanced reading: the deeper science (optional)

This section goes further than you need for your own treatment decisions. Kienböck's disease is worth the extra reading because of an uncomfortable finding that runs through its literature: the operations performed for it improve symptoms without clearly changing what the disease does to the bone.

Surgery relieves pain; it has not been shown to alter the disease

The most direct comparison available followed patients long-term after radial osteotomy against those treated non-operatively. Radial osteotomy was not superior to non-operative treatment in terms of disease progression by Lichtman stage — but it did produce better outcomes for pain and range of wrist motion [1].

Read that as two separate claims, because it is. The operation helps how the wrist feels and moves. It has not been demonstrated to stop the lunate collapsing. A later long-term comparison of non-operative treatment against vascularised bone grafting reached a similarly measured conclusion [2].

This is the single most useful thing to understand before consenting to surgery here. If an operation is offered as a way to save the lunate, that framing is ahead of the evidence. If it is offered as a way to reduce pain and preserve motion in a wrist that hurts now, that is supported.

Why the radiographs and the symptoms drift apart

Kienböck's is defined radiologically — the Lichtman stages describe sclerosis, then collapse, then carpal disintegration — and it is natural to assume the pictures track the pain. They frequently do not. Wrists progress radiologically while feeling better, and wrists hurt persistently at early stages.

That mismatch is why "the X-ray looks worse" is not by itself a reason to operate, and why serial imaging is a poor way to decide. The decision belongs to symptoms and function.

The operations are numerous, which is itself informative

Radial shortening, capitate shortening, vascularised bone grafting, core decompression, partial fusions, proximal row carpectomy — the number of described procedures is large. A systematic review of capitate shortening osteotomy is among the more recent additions [3].

In surgery, a long list of competing operations for one condition is usually a sign that none of them is decisively better. That is the honest reading here, and it explains why two reasonable surgeons may propose different procedures for the same wrist without either being wrong.

The unifying logic behind most of them is mechanical: reduce the load passing through the lunate, either by shortening the radius so the ulna carries more, or by shortening the capitate so less force is transmitted down onto the lunate. They are attempts to unload a bone whose blood supply is failing, not attempts to restore that blood supply — with the partial exception of vascularised grafting, which tries to do both.

What this means for you

Three practical consequences. Watchful waiting is a legitimate option rather than a failure to act, particularly if pain is tolerable. The purpose of any operation should be stated in terms of symptoms, not stage. And because no procedure has separated itself from the others, being told why this operation suits your wrist — your ulnar variance, your stage, your demands — matters more here than in most of hand surgery.

Reviewed by Kieran Hirpara · 27 April 2026.

Talk to your treating clinician for advice specific to you.

References for the advanced reading
  1. Shin YH, Kim JK, Han M, Lee TK, Yoon JO. Comparison of long-term outcomes of radial osteotomy and nonoperative treatment for Kienböck disease: a systematic review. J Bone Joint Surg Am. 2018;100(14):1231-40.
  2. Park JY, Kim JK, Shin YH. Comparison of long-term outcomes between nonoperative treatment and vascularized bone graft for Kienböck disease. Clin Orthop Surg. 2023;15(4):643.
  3. Simske N, Pourghaed M, Johnson C, Clark DM. Capitate shortening osteotomy for Kienböck's disease: a systematic review. Hand (N Y). 2026.
Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

  • Scaphocapitate arthrodesis yields discouraging functional outcomes in the medium-term follow-up for advanced stages of Kienböck disease [1].
  • Scaphocapitate arthrodesis demonstrates long-term clinical benefits for the treatment of collapsed Kienböck disease [5].
  • Radial osteotomies are effective in improving short-term clinical outcomes and radiographic findings in teenage patients with Kienböck disease [3].
  • Temporary scaphotrapezoidal joint fixation is recommended for the surgical treatment of adolescent Kienböck's disease [7].
  • Radial shortening osteotomy for symptomatic Kienböck's disease yields reasonable long-term function, although approximately one in eight patients undergo salvage surgery [8].
  • Good and excellent clinical and radiological outcomes can be achieved with both nonsurgical and surgical treatments in skeletally immature patients with Kienböck disease [9].
  • Children, adolescents, and elderly patients with Kienböck disease respond well to nonoperative treatments, which should be considered before any surgical intervention [11].
  • Capitate shortening is a safe and effective approach for the treatment of early stages of Kienböck's disease and can be associated with a satisfying outcome [13].
  • Tendon ball arthroplasty in advanced Kienböck's disease results in long-term satisfactory clinical outcomes despite widespread changes in the bones and joints within the wrist [16].
  • Advanced Kienböck's disease with carpal collapse is not a contraindication for carpal-sparing surgery via radial shortening osteotomy [21].
  • Radial shortening osteotomy offers at least comparable outcomes with proximal row carpectomy in treating Kienböck's disease, particularly in preserving joint function and patient satisfaction [22].

Anatomy & Pathophysiology

  • Wrist movement can reduce blood flow to the lunate bone [57].
  • The number of fractures does not correlate with carpal collapse, as fragmentation can occur early in the disease process [62].

Classification

  • The natural history of Kienböck's disease is generally considered a progressive condition that can end in Stage IV changes [4].
  • Kienböck's disease progresses substantially faster than previously described [6].
  • Contrary to current classifications, the articular cartilage of the lunate degenerates in early stages of Kienböck's disease [6].
  • Lunate morphology may affect the severity of Kienböck's disease at the time of initial presentation [10].
  • The Lichtman et al. classification for Kienböck's disease has good reliability and reproducibility [34].
  • The diagnosis of Kienböck's disease in the precollapse stages is not well defined, as evidenced by substantial interobserver variability on radiographs and magnetic resonance imaging [26].
  • Traditional radiographic indices measured on plain radiographs have poor diagnostic performance in the detection of carpal collapse in Kienböck's disease [15].
  • A unified classification and treatment algorithm coordinates osseous, vascular, and articular data alongside patient age to allow for more precise and individualized treatment plans [12].
  • A new treatment algorithm integrates traditional osseous classification with perfusion/viability and articular cartilage-based classifications [35].
  • The Bain and Begg arthroscopic classification and an articular-based approach to Kienböck's disease provide a high probability of good long-term relief of pain and a minimal chance of requiring a salvage procedure [44].

Clinical Presentation

  • Kienböck's disease is generally considered a progressive condition that can end in Stage IV changes [4].
  • The diagnosis of Kienböck's disease in the precollapse stages is not well defined, as evidenced by substantial interobserver variability among surgeons [26].
  • Dorsal wrist swelling in Kienböck's disease is a common manifestation and constitutes a part of the pathology of the disease [36].
  • Care should be taken to address dynamic pathology, not just the stage of the disease, when planning surgical treatment for Kienböck's disease [37].

Investigations

  • Computed tomography of the lunate is an important investigative tool in Kienböck's disease [43].
  • CT imaging is significantly more accurate than conventional radiography (CR) in determining the exact stage of Kienböck's disease [47].
  • Proton density–weighted MRIs reflect the extent and localization of the necrotic area in Kienböck-diseased lunates, as evidenced by comparison with histological analyses [45].
  • Fast-field echo images using a 47-mm microscopy coil do not reflect the extent and localization of the necrotic area in Kienböck-diseased lunates [45].

Treatment

Non-Operative Management

  • Nonoperative treatments are effective for children, adolescents, and elderly patients with Kienböck disease and should be considered before any surgical intervention [11].
  • Good and excellent clinical and radiological outcomes can be achieved with nonsurgical treatments in skeletally immature patients with Kienböck disease [9].
  • There is limited, low-quality evidence that surgical treatment slows progression of Kienböck's disease, and many uncontrolled case series document slight improvement in motion and grip after surgical treatment without clear evidence that this is better than placebo or no intervention [38].

Early-Stage Disease Interventions

  • Capitate shortening is a safe and effective approach for treatment of the early stages of Kienböck's disease and can be associated with a satisfying outcome [13].
  • Core decompression resulted in pain relief, radiological stability, and MRI normalization at 7-year follow-up in a case of early-stage Kienböck's disease, supporting the potential of disease-modifying treatments in early stages [18].
  • Arthroscopic lunate core decompression appears to be an effective and safe surgery for treating Kienböck disease on the basis of mid-term follow-up [39].

Radial Osteotomies

  • Radial osteotomies are effective in improving not only short-term clinical outcomes, but also radiographic findings in teenage patients with Kienböck disease [3].
  • Radial shortening osteotomy for symptomatic Kienböck's disease yields reasonable long-term function, though approximately one in eight patients underwent salvage surgery [8].
  • Radial shortening osteotomy provides decade-long improvement in 75% of patients and seems to be a reasonable treatment for symptomatic Kienböck’s disease [17].
  • Advanced Kienbock's disease with carpal collapse is not a contraindication for carpal-sparing surgery radial shortening osteotomy [21].
  • Radial shortening osteotomy offers at least comparable outcomes with proximal row carpectomy (PRC) in treating Kienböck's disease, particularly in preserving joint function and patient satisfaction [22].

Vascularized Bone Grafting

  • Vascularized bone grafting for stage III Kienböck disease demonstrated favorable long-term results and is recommended as a surgical treatment [14].
  • The treatment of Kienböck disease with vascularized bone graft from the dorsum of the radius has encouraging results and needs no other additional procedures [48].

Salvage and Fusion Procedures

  • Scaphocapitate arthrodesis is an effective procedure for treatment of Kienböck disease associated with satisfactory functional outcomes and significant improvement in pain scores and grip strength [20].
  • Scaphocapitate arthrodesis should be considered as a treatment option for wrist salvage in the patient with advanced Kienbock's disease given the significant postoperative reduction in associated pain symptoms at the time of follow-up [51].
  • Functional outcomes in medium-term follow-up are discouraging after scaphocapitate arthrodesis for advanced stages of Kienböck disease [1].
  • The long-term clinical benefits of scaphocapitate arthrodesis for treatment of collapsed Kienböck disease are demonstrated [5].

Adolescent-Specific Management

  • Temporary scaphotrapezoidal joint fixation is recommended for the surgical treatment of adolescent Kienböck's disease [7].
  • Surgical management of Kienböck's disease in adolescent patients can yield satisfactory outcomes in those that fail conservative management [25].

Complications

  • Scaphocapitate arthrodesis for advanced stages of Kienböck disease yields discouraging functional outcomes in medium-term follow-up [1].
  • Approximately one in eight patients with symptomatic Kienböck's disease undergo salvage surgery after radial shortening osteotomy [8].

Recovery

  • Radial osteotomies are effective in improving short-term clinical outcomes and radiographic findings in teenage patients with Kienböck disease [3].
  • Long-term clinical benefits of scaphocapitate arthrodesis for treatment of collapsed Kienböck disease are demonstrated [5].
  • Radial shortening osteotomy for symptomatic Kienböck's disease yields reasonable long-term function [8].
  • Approximately one in eight patients undergoing radial shortening osteotomy for symptomatic Kienböck's disease underwent salvage surgery [8].
  • Lunate morphology may affect the severity of Kienböck disease at the time of initial presentation [10].
  • Tendon ball arthroplasty in advanced Kienböck's disease results in long-term satisfactory clinical outcomes despite widespread changes in the bones and joints within the wrist [16].
  • Free vascularized iliac bone grafting for Kienböck's disease is a reasonable treatment option, and clinical and radiological improvements last for a long period of time [19].
  • Additional long-term study is needed to confirm the longitudinal relationship of negative ulnar variance with progressive Kienböck disease [27].
  • The longer-term results of titanium lunate arthroplasty (TLA) for stage III Kienböck disease are promising [28].
  • The medium- and long-term results of radial shortening osteotomy for Kienböck's disease in patients with negative ulnar variance are comparable to short-term results, providing long-lasting pain relief [29].
  • Radiographic progression of Kienböck over 1 year or more seems slight on average regardless of treatment [30].
  • Based on retrospective data from uncontrolled studies, no active treatment is superior in the treatment of Kienböck's disease [32].
  • There are insufficient data to determine whether the outcomes of any intervention are superior to placebo or the natural history of the disease [32].
  • Scaphocapitate arthrodesis with lunate excision performed in an advanced stage of Kienböck disease significantly alleviates pain, while preserving functional mobility and satisfactory grip strength in the long term [40].

Key Evidence

  • [L4] Nonetheless, functional outcomes in medium-term follow-up are discouraging after scaphocapitate arthrodesis for advanced stages of Kienböck disease. [1] (10.1016/j.jhsa.2013.08.063)
  • [L4] The current results indicate that radial osteotomies are effective in improving not only short-term clinical outcomes, but also radiographic findings in teenage patients with Kienböck disease. [3] (10.1097/01.blo.0000173254.46899.72)
  • [L5] The natural history of Kienbock's disease is not fully known, though it is generally considered a progressive condition that can end in Stage IV changes; treatment strategies focus on biomechanical unloading, vascularized bone grafts, or salvage procedures depending on the stage. [4] (10.1016/j.hcl.2006.07.003)
  • [L4] The long-term clinical benefits of scaphocapitate arthrodesis for treatment of collapsed Kienböck disease are demonstrated. [5] (10.1177/1753193413496177)
  • [L4] Kienböck's disease progresses substantially faster than previously described and, contrary to current classifications, the articular cartilage of the lunate degenerates in early stages. [6] (10.1016/j.jhsa.2014.06.032)
  • [L4] We therefore recommend this procedure for the surgical treatment of adolescent Kienböck's disease. [7] (10.1016/j.jhsa.2008.09.019)
  • [L4] Radial shortening osteotomy for symptomatic Kienböck's disease yields reasonable long-term function, though approximately one in eight patients underwent salvage surgery. [8] (10.1055/s-0040-1714750)
  • [L4] Good and excellent clinical and radiological outcomes can be achieved with both nonsurgical and surgical treatments in skeletally immature patients with Kienböck disease. [9] (10.1016/j.jhsa.2018.02.029)
  • [L3] Lunate morphology may affect the severity of Kienböck disease at the time of initial presentation. [10] (10.1016/j.jhsa.2014.12.024)
  • [L4] Children, adolescents, and elderly patients with Kienböck disease respond well to nonoperative treatments, and this should be considered before any surgical intervention. [11] (10.2106/jbjs.24.01090)
  • [L5] The authors propose a unified classification and treatment algorithm that coordinates osseous, vascular, and articular data alongside patient age to allow for more precise and individualized treatment plans for Kienböck disease. [12] (10.1016/j.jhsa.2022.03.014)
  • [L2] Capitate shortening is a safe and effective approach for treatment of the early stages of Kienböck's disease and can be associated with a satisfying outcome. [13] (10.1177/15589447221081564)
  • [L3] Vascularized bone grafting for stage III Kienböck disease demonstrated favorable long-term results and is recommended as a surgical treatment. [14] (10.1016/j.jhsa.2013.02.010)
  • [L3] Traditional radiographic indices measured on plain radiographs have poor diagnostic performance in the detection of carpal collapse in Kienböck's disease. [15] (10.1177/17531934231153966)
  • [L4] Tendon ball arthroplasty in advanced Kienböck's disease results in long-term satisfactory clinical outcomes, despite widespread changes in the bones and joints within the wrist. [16] (10.1177/1753193412471183)
  • [L4] Radial shortening osteotomy provides decade-long improvement in 75% of patients and seems to be a reasonable treatment for symptomatic Kienböck’s disease. [17] (10.1177/1753193413512222)
  • [L5] The article presents a case of early-stage Kienböck's disease where core decompression resulted in pain relief, radiological stability, and MRI normalization at 7-year follow-up, supporting the potential of disease-modifying treatments in early stages. [18] (10.1177/17531934221146851)
  • [L4] Free vascularized iliac bone grafting for Kienböck's disease is a reasonable treatment option, and clinical and radiological improvements last for a long period of time. [19] (10.1016/j.jhsa.2007.11.005)
  • [L4] Scaphocapitate arthrodesis is an effective procedure for treatment of Kienböck disease associated with satisfactory functional outcomes and significant improvement in pain scores and grip strength. [20] (10.1016/j.jhsg.2023.03.014)
  • [L4] Advanced Kienbock's disease with carpal collapse is not a contraindication for carpal-sparing surgery radial shortening osteotomy. [21] (10.1055/s-0039-1688947)
  • [L4] Radial shortening osteotomy offers at least comparable outcomes with PRC in treating Kienböck's disease, particularly in preserving joint function and patient satisfaction. [22] (10.1016/j.jhsa.2026.02.031)
  • [L4] Surgical management of Kienböck ' s disease in adolescent patients can yield satisfactory outcomes in those that fail conservative management. [25] (10.1055/s-0040-1701511)
  • [L4] Surgeons should be aware that the diagnosis of Kienböck disease in the precollapse stages is not well defined, as evidenced by the substantial interobserver variability. [26] (10.1177/1558944716677538)
  • [L2] Additional long-term study is needed to confirm the longitudinal relationship of negative ulnar variance with progressive Kienböck disease. [27] (10.1016/j.jhsa.2017.06.107)
  • [L4] The longer-term results of TLA for stage III Kienböck disease are promising. [28] (10.1016/j.jhsa.2018.02.009)
  • [L3] The medium- and long-term results of radial shortening osteotomy for Kienböck's disease in patients with negative ulnar variance are comparable to short-term results, providing long-lasting pain relief. [29] (10.1097/blo.0b013e318041d309)
  • [L4] Radiographic progression of Kienböck over 1 year or more seems slight on average regardless of treatment. [30] (10.1016/j.jhsa.2016.02.016)
  • [L4] Based on retrospective data from uncontrolled studies, no active treatment is superior in the treatment of Kienböck's disease and there are insufficient data to determine whether the outcomes of any intervention are superior to placebo or the natural history of the disease. [32] (10.1016/j.jhsa.2010.02.002)
  • [L4] The Lichtman et al. classification for Kienböck's disease has good reliability and reproducibility. [34] (10.1177/1753193410373862)
  • [L5] The manuscript reviews recent advances in diagnostics, classification, and treatment options for Kienböck disease to present a new treatment algorithm that integrates traditional osseous classification with perfusion/viability and articular cartilage-based classifications. [35] (10.1016/j.jhsa.2016.02.013)
  • [L3] Dorsal wrist swelling in Kienböck ' s disease is a common manifestation and constitutes a part of pathology of Kienböck ' s disease, although further study is required to clarify the relation between wrist swelling and etiology of Kienböck ' s disease. [36] (10.1055/s-0038-1661420)
  • [L4] Care should be taken to address dynamic pathology, not just the stage of the disease, when planning surgical treatment for Kienbock's disease. [37] (10.1177/1753193420987790)
  • [L5] There is limited, low-quality evidence that surgical treatment slows progression of Kienböck's disease, and many uncontrolled case series document slight improvement in motion and grip after surgical treatment without clear evidence that this is better than placebo or no intervention. [38] (10.1016/j.jhsa.2009.10.013)
  • [L4] Arthroscopic lunate core decompression appears to be an effective and safe surgery for treating Kienböck disease on the basis of mid-term follow-up. [39] (10.1016/j.jhsa.2023.02.011)
  • [L4] Scaphocapitate arthrodesis with lunate excision performed in an advanced stage of Kienböck disease significantly alleviates pain, while preserving functional mobility and satisfactory grip strength in the long term. [40] (10.1177/1753193417739247)
  • [L4] Computed tomography of the lunate in Kienböck disease is an important investigative tool. [43] (10.1016/j.jhsa.2018.05.008)
  • [L4] This study confirms that the Bain and Begg arthroscopic classification and an articular-based approach to Kienböck disease provide a high probability of good longterm relief of pain and a minimal chance of requiring a salvage procedure. [44] (10.1016/j.jhsa.2020.11.004)
  • [L4] Proton density–weighted MRIs but not fast-field echo images using a 47-mm microscopy coil reflected the extent and localization of the necrotic area in Kienböck-diseased lunates, as evidenced by comparison with histological analyses of the lunate specimens. [45] (10.1016/j.jhsa.2011.09.027)
  • [L3] CT imaging is significantly more accurate than CR in determining the exact stage of Kienböck's disease. [47] (10.1177/17531934241286115)
  • [L4] The treatment of Kienböck disease with vascularized bone graft from the dorsum of the radius has encouraging results and needs no other additional procedures. [48] (10.1007/s00402-008-0586-x)
  • [L4] Given the significant postoperative reduction in associated pain symptoms at the time of follow-up, scaphocapitate arthrodesis should be considered as a treatment option for wrist salvage in the patient with advanced Kienbock's disease. [51] (10.1007/s11552-014-9705-z)
  • [L4] Wrist movement can reduce blood flow to the lunate bone. [57] (10.1186/s12891-019-2492-5)
  • [L4] The number of fractures does not correlate with carpal collapse, as fragmentation can occur early in the disease process. [62] (10.1055/s-0039-1688993)

References

[1] Scaphocapitate Arthrodesis in the Treatment of Kienböck Disease. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.08.063

[3] Radial Osteotomies for Teenage Patients with Kienb??ck Disease. Clinical Orthopaedics and Related Research. 2005. DOI: 10.1097/01.blo.0000173254.46899.72

[4] Kienböck's Disease: An Approach to Treatment. Hand Clinics. 2006. DOI: 10.1016/j.hcl.2006.07.003

[5] Scaphocapitate arthrodesis for treatment of late stage Kienböck disease. Journal of Hand Surgery (European Volume). 2013. DOI: 10.1177/1753193413496177

[6] Characteristic Features and Natural Evolution of Kienböck Disease: Five Years Results of a Prospective Case Series and Retrospective Case Series of 106 Patients. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.06.032

[7] Temporary Scaphotrapezoidal Joint Fixation for Adolescent Kienböck's Disease. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2008.09.019

[8] Radial Shortening Osteotomy for Symptomatic Kienböck's Disease: Complications and Long-Term Patient-Reported Outcome. Journal of Wrist Surgery. 2020. DOI: 10.1055/s-0040-1714750

[9] Kienböck Disease in the Skeletally Immature Patient. The Journal of Hand Surgery. 2018. DOI: 10.1016/j.jhsa.2018.02.029

[10] The Effect of Lunate Morphology in Kienböck Disease. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2014.12.024

[11] Kienböck Disease: Recent Advances in Understanding and Management. Journal of Bone and Joint Surgery. 2025. DOI: 10.2106/jbjs.24.01090

[12] Precision Medicine for Kienböck Disease in the 21st Century. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2022.03.014

[13] Comparing the Radiologic and Functional Outcome of Radial Shortening Versus Capitate Shortening in Management of Kienböck’s Disease. HAND. 2022. DOI: 10.1177/15589447221081564

[14] Long-Term Results of Vascularized Bone Graft for Stage III Kienböck Disease. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.02.010

[15] Diagnostic performance of traditional radiographic indices in detection of carpal collapse in Kienböck’s disease. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934231153966

[16] Long-term clinical results and MRI changes after tendon ball arthroplasty for advanced Kienböck’s disease. Journal of Hand Surgery (European Volume). 2013. DOI: 10.1177/1753193412471183

[17] Long-term outcome (20 to 33 years) of radial shortening osteotomy for Kienböck’s lunatomalacia. Journal of Hand Surgery (European Volume). 2013. DOI: 10.1177/1753193413512222

[18] Kienböck’s disease: preventing disease progression in early-stage disease. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934221146851

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[20] Clinical and Radiological Outcomes of Scaphocapitate Fusion in Kienböck Disease: A Systematic Review and Meta-Analysis. Journal of Hand Surgery Global Online. 2023. DOI: 10.1016/j.jhsg.2023.03.014

[21] Treatment of Advanced Kienbock's Disease (Lichtman Stage IIIB with Carpal Collapse) by a Shortening Osteotomy of the Radius: 21 Cases. Journal of Wrist Surgery. 2019. DOI: 10.1055/s-0039-1688947

[22] Save or Salvage: Radial Shortening Osteotomy and Proximal Row Carpectomy in Kienböck’s Disease—A Descriptive Study. The Journal of Hand Surgery. 2026. DOI: 10.1016/j.jhsa.2026.02.031

[25] Adolescent Kienböck's Disease: A Comparison between Lunate Offloading and Revascularization Procedures. Journal of Wrist Surgery. 2020. DOI: 10.1055/s-0040-1701511

[26] Interobserver Agreement in Diagnosing Early-Stage Kienböck Disease on Radiographs and Magnetic Resonance Imaging. HAND. 2016. DOI: 10.1177/1558944716677538

[27] Risk Factors of Lunate Collapse in Kienböck Disease. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.06.107

[28] Long-Term Clinical Outcome After Titanium Lunate Arthroplasty for Kienböck Disease. The Journal of Hand Surgery. 2018. DOI: 10.1016/j.jhsa.2018.02.009

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[30] Radiographic Progression of Kienböck Disease: Radial Shortening Versus No Surgery. The Journal of Hand Surgery. 2016. DOI: 10.1016/j.jhsa.2016.02.016

[32] Systematic Review of the Treatment of Kienböck's Disease in Its Early and Late Stages. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.02.002

[34] Reliability and reproducibility of Kienböck’s disease staging. Journal of Hand Surgery (European Volume). 2010. DOI: 10.1177/1753193410373862

[35] Kienböck Disease: Moving Forward. The Journal of Hand Surgery. 2016. DOI: 10.1016/j.jhsa.2016.02.013

[36] Wrist Swelling in Kienböck's Disease. Journal of Wrist Surgery. 2018. DOI: 10.1055/s-0038-1661420

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[38] Kienböck's Disease. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2009.10.013

[39] Arthroscopic Treatment of Kienböck Disease: Mid-Term Outcome of Arthroscopic Lunate Core Decompression. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2023.02.011

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[43] Fixation of the Fractured Lunate in Kienböck Disease. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2018.05.008

[44] Long-Term Outcome of Surgical Treatment for Kienböck Disease Using an Articular-Based Classification. The Journal of Hand Surgery. 2021. DOI: 10.1016/j.jhsa.2020.11.004

[45] Correlation of Histopathology With Magnetic Resonance Imaging in Kienböck Disease. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2011.09.027

[47] Radiography versus computed tomography for osseous staging of Kienböck’s disease. Journal of Hand Surgery (European Volume). 2024. DOI: 10.1177/17531934241286115

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[51] Limited Intercarpal Fusion as a Salvage Procedure for Advanced Kienbock Disease. HAND. 2014. DOI: 10.1007/s11552-014-9705-z

[57] Superselective angiography of the wrist in patients with Kienböck’s disease. BMC Musculoskeletal Disorders. 2019. DOI: 10.1186/s12891-019-2492-5

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