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Kienböck's Disease (Lunate Avascular Necrosis)
Kienböck's disease is avascular necrosis (bone death from loss of blood supply) of the lunate, one of eight small carpal bones in the wrist - it typically affects young adults aged 20-40 years, especially manual laborers, causing progressive wrist pain, stiffness, and weakness over months to years - the lunate bone gradually collapses causing wrist arthritis if untreated - treatment depends on Lichtman staging (I-IV): early stages (I-II) may respond to immobilization or joint-leveling procedures (radial shortening or ulnar lengthening osteotomy) unloading the lunate and allowing revascularization in 50-60% of cases, while advanced stages (III-IV) with lunate collapse and arthritis require salvage procedures (proximal row carpectomy or wrist fusion) sacrificing wrist motion for pain relief.
📖What is Kienböck's Disease (Lunate Avascular Necrosis)?
Kienböck's disease is avascular necrosis (bone death from loss of blood supply) of the lunate, one of eight small carpal bones in the wrist - it typically affects young adults aged 20-40 years, especially manual laborers, causing progressive wrist pain, stiffness, and weakness over months to years - the lunate bone gradually collapses causing wrist arthritis if untreated - treatment depends on Lichtman staging (I-IV): early stages (I-II) may respond to immobilization or joint-leveling procedures (radial shortening or ulnar lengthening osteotomy) unloading the lunate and allowing revascularization in 50-60% of cases, while advanced stages (III-IV) with lunate collapse and arthritis require salvage procedures (proximal row carpectomy or wrist fusion) sacrificing wrist motion for pain relief.
🔬What Causes It?
- Lunate blood supply disruption (precarious blood supply entering lunate from only 2-3 small vessels)
- Ulnar negative variance (ulna 2-4mm shorter than radius) causing increased load on lunate in 75% of Kienböck's patients
- Repetitive microtrauma from manual labor (jackhammer use, gymnastics, racquet sports)
- Single traumatic injury to wrist potentially disrupting lunate blood supply
- Unknown in many cases - idiopathic AVN
⚠️Risk Factors
You may be at higher risk if:
- Manual labor occupations (construction, jackhammer operators, factory work)
- Repetitive impact loading sports (gymnastics, weightlifting, racquet sports)
- Ulnar negative variance (short ulna - present in only 23% of normal population but 75% of Kienböck's)
- Age 20-40 years (peak incidence)
- Male gender (slight male predominance)
🛡️Prevention
- ✓Reduce repetitive impact loading if possible (ergonomic modifications, job rotation)
- ✓Use proper technique and equipment for manual labor activities
- ✓Prompt evaluation of wrist injuries (early diagnosis improves outcomes)
- ✓Consider screening MRI for at-risk populations (manual laborers with wrist pain)
- ✓Accept that many cases occur spontaneously without clear preventable cause