Beware! Pain in Your Wrist Might Be a Symptom of Rare Kienbock’s Disease

By Dr. Aditya Mani Gupta in Orthopaedics & Joint Replacement

May 13, 2020

You might have fractured or sprained your wrist while playing, doing your daily chores, or unfortunately in an accident, causing you a lot of pain. However, if you experience pain in your wrist without any untoward incident, then it may be due to an underlying disease. There are several such conditions that can cause acute wrist pain, such as Carpal Tunnel Syndrome, Arthritis, Repetitive Strain Injury, Tendonitis, etc.

Apart from these conditions, there are other rare conditions that can also lead to severe wrist pain. One such condition is Kienbock’s disease (or idiopathic avascular necrosis of the lunate), a rare condition that is caused by loss of blood supply to the lunate bone (one of the eight small bones located in the wrist).  The lunate bone is vital for joint and proper wrist movement, the damage to bone can lead to, severe pain, inflamed wrist muscles, and sometimes wrist immobility.

Causes of Kienbock’s Disease

Kienbock’s disease can be caused by several factors, however, this condition is usually associated with accidental damage to the wrist, leading to the obstruction of blood supply to the lunate bone. Even repetitive minor injuries can cause Kienbock’s disease over time.

Co-morbidities affecting the blood circulation can also lead to the Kienbock’s disease. Other medical conditions such as lupus, sickle cell anemia, and cerebral palsy also have been recognized as the cause of this condition.Symptoms of Kienbock’s Disease

Apart from severe pain in the wrist, one can identify the Kienbock’s Disease if they have.

• Muscle tenderness over the bone
• Inflamed wrist
• Reduced grip strength
• Difficulty in wrist movement
• Clicking sound at wrist movement

If these conditions persist, it is advisable to consult a doctor at the best multispeciality hospital in India.

Diagnosis of Kienbock’s Disease

As this is a rare condition, usually normal wrist pains are not associated with it. However, in case of persistent pain and discomfort, doctors prescribe CT Scans and MRIs for investigating the wrist for possible causes.

Kienbock’s Disease is diagnosed when MRIs or CT scan shows a loss of blood supply to the lunate bone.

It should be noted these conditions usually go unnoticed for a long period due to non-consultation and neglection by the patient. This can lead to the severity of the condition in later stages, so it is advisable to consult a specialist at a super speciality hospital for early diagnosis of the condition.

Recommended Treatments for Kienbock’s Disease

The treatment depends upon the severity of the condition, in early stages doctors at the Best Orthopedic Hospitals in Delhi may try to reduce the inflammation and restore the blood flow through anti-inflammatory medications and immobilization of wrist with help of external equipment.

In case, there is no improvement in the condition, Orthopedic surgeon may prescribe surgery. There are several surgical options that can be prescribed depending upon the condition and comfort of the patient.

• Revascularization:Procedure for grafting a piece of bone and blood vessels to restore the blood flow.
• Capitate-shortening osteotomy: A piece of wrist bone is removed and fused with the other segments of the same bone.
• Joint levelling: This is done to level the two forearm bones, in case one of them is shorter or longer. This can be done by scraping the two bones involved to level them, this procedure is termed as Metaphyseal core decompression.
• Proximal row corpectomy: removes the damaged lunate, however, it leads to partial wrist movement.
• Arthroplasty: This would include a total wrist joint replacement with an artificial limb.

As this is a rare condition, it requires a prompt response from a qualified and experienced team of consultants and surgeons.  At Metro Hospitals, our team has conducted several such procedures and we have also found mention in several journals for these accomplishments. One such case involves the treatment of a 29-year-old female with a history of pain and swelling in the right wrist for many months. After a physical examination and analysis of various factors, she was diagnosed with an advanced condition of Kienbock’s disease.She was counselled about the treatment and need for physiotherapy. She was advised to go for lunate excision and carpal arthrodesis surgery. After the successful procedure, her pain has reduced drastically, range of motion improved by several degrees, and her grip strength improved from a mere 57.20% of normal side to 70.57% post-surgery.

Our team at Metro Hospitals believes in the patient-first approach and tries their best to provide the best treatment in the world through their years of expertise.

We at the metro group of hospitals are always committed to realizing the vision of providing world-class healthcare at an affordable cost and to achieve excellence in Healthcare services by offering exceptional care through state-of-the-art technology.

The Metro Group was established in the year 1997 by Padama Vibhusan, Padma Bhusan and Dr. B C Roy National Awardee Dr. Purshotam Lal with the vision to provide world-class healthcare amenities to his countrymen at an affordable cost.

Metro Group of Hospitals are the leading healthcare centers in our country boasting an ultra-modern infrastructure providing multispeciality care by an exceptional team of healthcare professionals under the leadership of world-renowned interventional cardiologist Dr. Purshotam Lal. We at Metro hospitals provide multispecialty care for 35 Chief and Allied-specialities that include Anaesthesiology, Cardiology & CTVS, Dentistry, Gastroenterology & Gastro Surgery, Internal Medicine, Neurosciences, Obstetrics and Gynaecology, Oncology & Onco Surgery, Orthopaedics, Joint Replacement & Spine Surgery, Paediatrics & Neonatology, Physiotherapy Plastic, Cosmetic & Reconstructive Surgery, Pulmonology & Sleep Medicine, Rheumatology, Stem Cell Therapy, Bariatric & Metabolic Surgery, Blood Bank, Dermatology, Endocrinology And Diabetes, ENT & Cochlear Implant, Haemotology, Holistic Medicine, Homeopathy, Interventional Radiology Laboratory, Laparoscopic & General Surgery, Nephrology & Renal Transplant, Nutrition & Health, Ophthalmology, Metro Eye Centre, Psychiatry, Psychology, Radiology, and Urology.

Dr. Purshottam Lal is an internationally acclaimed Interventional Cardiologist who epitomizes the best in professional excellence and service to humanity, especially the poor and the needy.

Dr. Lal was trained at world renowned medical institutions in the UK, Germany, and the USA. He is fellow of American College of Cardiology, American College of Medicine, Royal College of Physician (Canada), British Cardiovascular Interventional Society, German Society of Cardiovascular Research, Fellow of Society of Cardiac Angiography and Interventions, USA, etc. He has the unique distinction of pioneering the largest number of procedures in the field of Interventional Cardiology for the first time in the country such as Slow Rotational Angioplasty, Atherectomy, Rotablator, Stenting, Heart hole closure, etc.

He has developed techniques of Aortofemoral bypass support (partial artificial heart), Opening of tight heart valves with echo without cath lab. He has performed the first case of Non-surgical heart hole closure (ASD) with monodisc device and the first case of Non-surgical aortic valve replacement with core valve, both being the first time in the world. He is the first investigator of Inoue Balloon Mitral Valvuloplasty in the Country and his name has been listed in the ‘Limca Book of World Records’.

A crusader against unethical commercialization of medical services, he has committed himself to provide to the middle class, poor and the needy the latest cardio-vascular procedures at the most affordable cost. In pursuance of his mission, he has established thirteen state-of-the-art Hospitals and three satellite units. Such is Dr. Lal’s commitment to his mission that an ever-increasing number of poor patients have been treated either free of cost or at concessional rates and ‘No patient is ever turned back for want of money’. He has been named as ‘Creator of Affordable Healthcare’ by ‘Express Healthcare’, a leading health magazine and has been a trendsetter for NRIs to return to India to serve the needy people.

Dr. Lal has been decorated with several prestigious awards:–

• 2nd Jawaharlal Nehru International Excellence Award (1990), Rajiv Gandhi Award (1991), Dr.V.V.Shah Oration Gold Medal by Cardiological Society of India (1992) for his pioneering contributions in Interventional Cardiology.

•   Distinguished Achievement Award of Highest Order by the National Forum of Indian Medical Association (2006-07) for performing the largest number of angioplasties/stenting as a single operator in the country. 

•  ‘Life Time Achievement Award’ by Shri Arun Jaitley on behalf of Delhi Medical Association and ‘Life Time Achievement Award’ by Dr. Lilly Engineer, Professor of Harvard University on behalf of ‘Times of India’.

• Padma Bhushan (2003), prestigious Dr. B.C.Roy National Award (2004) and Padma Vibhushan (2009) by the President of India.

He has contributed over one hundred research papers, articles, chapters and authored a book “Cause and Prevention of Heart Diseases”. He has been a Member at Central Council of Health and Family Welfare, Expert Committee for medical devices, Ministry of Health, Govt. of India, Delhi Medical Council, Standing Committee ESI Corporation – Ministry of Labour & Employment, Govt. of India and Member Board of Governors, Medical Council of India from May 2011 to May 2013.