Wrist pain– This is a sort of pain which usually is prevalent in people who are involved in repetitive activity at work, which may result in different medical conditions affecting the wrist resulting in pain. Pain in the wrist may affect an individual’s ability to work appropriately whether household chores or at the workplace. One such condition which results in wrist pain is Lunatomalacia or Kienbock’s Disease in which there is a collapse of the lunate bone of the wrist. In this article, we will go in detail about various causes, symptoms, and various methods of managing Lunatomalacia or Kienbock’s Disease.
What Is Lunatomalacia or Kienbock’s Disease?
Lunatomalacia or Kienbock’s Disease is a medical condition in which there is a collapse of lunate bones in the wrist. This is generally caused as a result of vascular insufficiency and avascular necrosis of lunate. This is generally unilateral or one sided.
Causes of Lunatomalacia or Kienbock’s Disease
The avascular necrosis resulting in the collapse of the lunate bone in the wrist is caused by impairment of blood supply to the lunate bone, which may be as a result of the following factors:
- Solitary or repetitive microfractures.
- Repeated compression of lunate between capitate bone and distal radius.
- Extreme wrist positioning.
Symptoms of Lunatomalacia or Kienbock’s Disease
Lunatomalacia or Kienbock’s Disease is difficult to diagnose in its early phases as the symptoms are quite similar to a simple wrist sprain.
Lunatomalacia or Kienbock’s Disease presents itself with wrist pain and tenderness over the lunate bone. This pain may then radiate up the wrist to the forearm. There is associated stiffness at the wrist. Lunatomalacia may result from repetitive injury to the wrist which may be due to overuse of the wrist. There may be swelling over the lunate bone. Passive dorsiflexion of middle finger may result in reproduction of pain. Range of motion of the wrist is reduced in dorsiflexion and extension. There is weakness of grip strength. These are progress gradually as the lunate bone collapses and there are degenerative changes.
Diagnosis of Lunatomalacia or Kienbock’s Disease
Lunatomalacia or Kienbock’s Disease Is Diagnosed By The Following Studies:
Wrist X-ray: This may initially be normal or reveal sclerosis of lunate. There may also be presence of ulnar variance. There is progressive loss of height and fragmentation of the lunate bone. To identify Lunatomalacia in its early stages, an MRI is extremely helpful.
Treatment for Lunatomalacia or Kienbock’s Disease
In the early stages of the disease the aim of treatment is to reduce the compression of the lunate bone. This can be done by splinting and use of NSAIDs. Surgery may be required to relieve the pressure off the lunate bone. In case of a positive ulnar variance, to get a negative ulnar variance the following may be done
- Radial shortening
- Ulnar lengthening
- Fusion of capitate and hamate
In Case Of Delayed Diagnosis or In The Later Stages Of Lunatomalacia or Kienbock’s Disease, The Following Procedure May Be Done:
- Wrist arthrodesis.
- Proximal row carpectomy.
How Can You Prevent Lunatomalacia or Kienbock’s Disease From Occurring?
First and foremost is the awareness of this disease and then employing ways to prevent progression of this disease. This can be done by avoiding repetitive use of the wrist so as to avoid overuse of the wrist.
- “Lunatomalacia” – StatPearls, NCBI https://www.ncbi.nlm.nih.gov/books/NBK534828/
- “Kienbock Disease” – American Society for Surgery of the Hand https://www.assh.org/handcare/hand-arm-conditions/kienbocks-disease