Information
Editors
Lunatomalacia (Kienböck's Disease)
Essentials
- A rare condition that is most often encountered in the dominant hand of young (20-35 years) male manual workers
- First-line treatment consists of avoiding exertion of the affected hand. Surgery is considered if symptoms are not alleviated after 2 months of rest.
Diagnosis
- The pathogenesis of the condition is not known. It is suspected that repeated microtraumas might have a role in the condition manifesting itself.
- Symptoms are periodical and often resolve over the years. Particularly in the early stages there may also be synovitis in the wrist, which causes swelling and pain.
- Initially, there is wrist pain on exertion, which later changes to rest pain. The maximal pain is felt over the lunatum.
- Dorsiflexion of the wrist is restricted and painful.
- Grip strength is decreased.
- The condition must be kept in mind in cases where a young man complains of pain in the middle of the wrist that has lasted several weeks and there are symptoms also at rest.
- X-ray usually shows signs of the disease only in the later stages.
- Initially a reduction in the calcium content of the lunate bone is seen, later fragmentation and collapse (picture 1).
- MRI finding is abnormal from the initial stage of the condition.
Treatment
- In suspected lunatomalacia, straining of the wrist should be avoided and it is advisable to support the wrist e.g. with an orthosis fastened with Velcro tape.
- If the symptoms are not completely resolved after 2 months of rest, the patient should be referred to a hand surgery unit for closer diagnosis and treatment.
- The method of treatment is chosen according to the severity of the disease. The most common surgical techniques are shortening of the radius and lunate revascularization with a vascular bone graft. In more severe cases, a partial or complete wrist arthrodesis needs to be considered.
References