Kienbock's illness is also known as avascular necrosis. Kienbock's illness is a condition in which one of the little bones of the wrist loses its blood supply and dies, causing pain and hardness with wrist movement. In the late stages of the disease, the bone collapses, shifting the position of other bones in the wrist. This shifting finally leads to degenerative changes and osteoarthritis in the joint. It occurs most frequently in young adults between 15 and 40 years of age. Kienbock's disease affects less than 200,000 people in the U.S. population. In most people, two vessels supply blood to the lunate, but in some people there is only one source. This puts them at greater risk for developing the illness. As the disease progresses, other signs and symptoms are noted, including painful and sometimes swollen wrist, limited array of motion in the affected wrist, reduced grip strength in the hand, softness directly over the bone, and pain or difficulty in turning the hand upward. The reason of Kienbock’s disease seems to engross multiple factors. These factors comprise the blood supply (arteries), the blood drainage (veins), and skeletal variations. Skeletal variations associated with Kienbock’s disease include a shorter length of the ulna, one of the forearm bones, and the shape of the lunate bone itself There may be several cases that are related with diseases like gout, sickle cell anemia, and cerebral palsy. Treatment options depend upon the severity and stage of the disease. There are several nonsurgical and surgical options for treating this disease. Anti-inflammatory drugs, such as aspirin or ibuprofen, will assist to alleviate any pain and decrease swelling. Surgery is usually considered to try to reduce the load on the lunate bone by lengthening, shortening, or fusing various bones in the forearm or wrist. Sometimes bone grafting or removal of the diseased lunate is performed. There are many surgical options for treating the more-advanced stages of Kienbck's disease. In several cases, it may be possible to revisit the blood supply to the bone. This procedure takes portion of bone from the inner bone of the lower arm. A metal device may be used to alleviate pressure on the lunate and preserve the spacing between bones. If the bones of the lower arm are uneven in length, a joint leveling procedure may be recommended. Bones can be made longer using bone grafts or shortened by removing a section of the bone. This leveling procedure diminishes the forces that bear down on the lunate and seems to halt progression of the disease.
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