Kienböck's Disease-OrthoInfo - AAOS Copyright 2012 American Academy of Orthopaedic Surgeons Kienböck's Disease Kienböck's disease is a condition where the blood supply to one of the small bones in the wrist, the lunate, is interrupted. Bone is living tissue that requires a regular supply of blood for nourishment. If the blood supply to a bone stops, the bone can die. This is called osteonecrosis. Damage to the lunate causes a painful, stiff wrist and, over time, can lead to arthritis. Normal skeletal anatomy of the hand. Reproduced and modified with permission from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010. Cause The cause of Kienböck's disease is not known. Many people with Kienböck's disease think they have a sprained wrist at first. They may have experienced some form of trauma to the wrist, such as a fall. This type of trauma can disrupt the blood flow to the lunate. Some things may put you more at risk for the disease.

For example, most people have two vessels that supply blood to the lunate, but in some people there is only one source. This may slow the blood flow to the bone. In addition, if the two bones of the forearm (the radius and ulna) are different lengths, extra pressure can be put on the lunate during some wrist motions. Over time, this extra stress on the bone may lead to Kienböck's disease. The most common symptoms of Kienböck's disease include: A painful and sometimes swollen wrist Limited range of motion in the affected wrist (stiffness) Decreased grip strength in the hand Tenderness directly over the bone (on the top of the hand at about the middle of the wrist) Pain or difficulty in turning the hand upward Top of page Doctor Examination Kienböck's disease is a condition that progresses slowly, and many people do not decide to see a doctor until they have lived with symptoms for several months, perhaps longer. During your first appointment, your doctor will discuss your symptoms and medical history, then examine your hand and wrist. In its early stages, Kienböck's disease may be difficult for your doctor to diagnose because the symptoms are so similar to those of a sprained wrist.

Imaging tests, such as x-rays and magnetic resonance imaging (MRI) scans, are used to confirm a diagnosis of Kienböck's disease. Kienböck's disease progresses through four stages of severity. If you are diagnosed with Kienböck's disease, your doctor will plan your treatment based on several factors, most importantly, the stage of your progression. Stage 1 During the first stage of the disease, the symptoms are similar to those of a wrist sprain. Although the blood supply to the lunate has been disrupted, x-rays may still appear normal or suggest a possible fracture. An MRI scan can better detect blood flow and is helpful in making the diagnosis in this early stage. Stage 1. (Left) This illustration shows a fracture of the lunate during the early phase of the disease. (Right) An x-ray of a patient's wrist during Stage I shows no deterioration of the lunate bone. Reproduced and adapted with permission from Allan CH, Joshi A, Lichtman DM: Kienböck's disease: diagnosis and treatment. J Am Acad Orthop Surg 2001; 9 : 128-136.

Stage 2 The lunate bone begins to harden due to the lack of blood supply during Stage 2. This hardening process is called sclerosis. In addition, the lunate will appear brighter or whiter in areas on x-rays, which indicates that the bone is dying. To better assess the condition of the lunate, your doctor may also order either MRI scans or computed tomography (CT) scans. The most common symptoms during this stage are wrist pain, swelling, and tenderness. Stage 2. (Left) This illustration shows that the lunate has hardened with more than one fracture line. (Right) The lunate is brighter than the surrounding bones, which indicates that the bone is dying. Reproduced and adapted with permission from Allan CH, Joshi A, Lichtman DM: Kienböck's disease: diagnosis and treatment. J Am Acad Orthop Surg 2001; 9 : 128-136. Stage 3 In Stage 3, the dead lunate bone begins to collapse and break into pieces. As the bone begins to break apart, the surrounding bones may begin to shift position. During this stage, patients typically experience increasing pain, weakness in gripping, and limited wrist motion.

Stage 3. Both the illustration and x-ray image show that the lunate has begun to collapse and several bones in the wrist have shifted out of position. Reproduced and adapted with permission from Allan CH, Joshi A, Lichtman DM: Kienböck's disease: diagnosis and treatment. J Am Acad Orthop Surg 2001; 9 : 128-136. Stage 4 If the condition progresses to Stage 4, the surfaces of the bones surrounding the lunate also deteriorate, and the wrist may become arthritic. Stage 4. (Left) This illustration shows damage to several bones in the wrist. (Right) This CT scan also shows deterioration in the bones of the wrist. Reproduced and adapted with permission from Allan CH, Joshi A, Lichtman DM: Kienböck's disease: diagnosis and treatment. J Am Acad Orthop Surg 2001; 9 : 128-136. Top of page Treatment Although there is no complete cure for Kienböck's disease, there are several nonsurgical and surgical options for treating it.

The goals of treatment are to relieve the pressure on the lunate and to try to restore blood flow within the bone. Nonsurgical Treatment In the very early stage of the disease, pain and swelling may be managed with anti-inflammatory medications, such as aspirin or ibuprofen. Immobilizing your wrist for a period of time can help relieve pressure on the lunate, and your doctor may recommend splinting or casting for 2 to 3 weeks. It is important to monitor any changes in your symptoms during the early stage of Kienböck's disease. If the pain is not relieved with simple treatments or it returns, your doctor may recommend surgery. Surgical Treatment There are several surgical options for treating Kienböck's disease. The choice of procedure will depend on several factors, in particular how far the disease has progressed. Additional factors to consider are the patient's activity level, personal goals, and the surgeon's experience with the procedures. Revascularization. In some cases, it may be possible to return the blood supply to the lunate bone. This procedure is called revascularization. It is more successful during early phases of the disease — stages 1 and 2 — before the lunate has significantly deteriorated.

Revascularization involves removing a portion of bone with attached blood vessels from another bone — most often a forearm bone (radius) or an adjacent bone in the hand. This piece of bone with its blood supply is called a vascularized graft. It is inserted into the lunate bone. To help the bones stay in place during healing, an external fixator may be temporarily applied. This is a metal device that is attached to the outside of the wrist with pins that insert into the bones. It can relieve pressure on the lunate while the graft is healing and restoring a blood supply. Joint leveling. If the two bones of the lower arm are not the same 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 reduces the forces that compress the lunate and often stops the progression of the disease. Proximal row carpectomy. If the lunate is severely collapsed or broken into pieces, it can be removed. In this procedure, the two bones on either side of the lunate are also removed. This procedure, called a proximal row carpectomy, will relieve pain while maintaining partial wrist motion.

(Left) The three wrist bones that are removed in a proximal row carpectomy, are shaded here. (Right) An x-ray image of a wrist after a proximal row carpectomy. Fusion. To ease pressure on the lunate, nearby wrist bones can be fused together to make one, solid bone. A fusion can be partial, in which just some of the bones are fused together. This procedure relieves pain and retains some wrist motion. If the disease has progressed to severe arthritis of the wrist, fusing all of the bones of the wrist to the radius will relieve pain and and improve hand function. Although all wrist motion is eliminated in a complete fusion, forearm rotation is preserved. In a fusion, the bones of the wrist are held together with a combination of a plate, screws, and pins. Top of page Outcomes Kienböck's disease varies considerably in its severity, as well as its rate of progression. Each patient's response to treatment depends on the degree of damage to the lunate and surrounding wrist bones. Some patients may require more than one procedure if the disease continues to progress. In summary, patients with Kienböck's disease should not expect to ever return to normal wrist function after any treatment.

However, treatment gives the greatest opportunity for long-term preservation of function and pain relief. Lunate fractures - OrthopaedicsOne Articles - OrthopaedicsOne Lunate fractures Introduction The lunate is the fourth most fractures carpal bone (following the scaphoid, triquetrum, and trapezium). They often are not diagnosed initially and present delayed as lunate osteonecrosis, which is also known as Kienbock disease. The mechanism of injury is typically a fall onto an outstretched hand with a hyperextended wrist or during a forceful push with an extended wrist. Anatomy The lunate can be considered a "carpal keystone", since it resides within a protected concavity of the distal radius (lunate fossa). The lunate is attached to the scaphoid and triquetrum via interosseous ligaments. Distally, it is articulates with the convex head of the capitate. It is supplied by a proximal carpal vascular arcade volarly and dorsally. There are three variable intralunate anastomoses.

Classification Osteochondral fractures of the proximal articular surface without substantial damage to the nutrient vessels Presentation Patients often present with palpation tenderness on the volar wrist. Wrist range of motion is usually painful. Diagnosis Standard PA and lateral radiographs of the wrist are often inadequate to detect a lunate fracture because of overlapping radiodensities. Oblique views may be slightly more helpful; however, MRI, CT, or bone scintigraphy is often needed. MRI is also helpful for evaluating healing, vascular injury, and sings of osteonecrosis. Treatment Nondisplaced fractures can be treated with cast immobilization (short or long arm). Follow-up must proceed at close intervals to monitor healing and possible progression to Kienbock disease. Displaced or angulated fractures require surgical apposition to allow healing of the vascular supply to the lunate. Complications Kienboeck disease is osteonecrosis of the lunate and can lead to devastating advanced collapse and radiocarpal arthrosis. Surgical intervention may be necessary for pain relief if severe.

The options for surgical management of Kienbock disease includes radial wedge osteotomy, radial shortening, ulnar lengthening, or salvage procedures such as arthrodesis or proximal row carpectomy. Peer Review OrthopaedicsOne Peer Review Workflow is an innovative platform that allows the process of peer review to occur right within an OrthopaedicsOne article in an open, transparent and flexible manner. Learn more Instructions for Authors Read our Instructions for Authors to learn about contributing or editing articles on OrthopaedicsOne. Content Partner Learn about becoming an OrthopaedicsOne Content Partner . Academic Resources Resources on Lunate fractures from Pubget. Orthopaedic Web Links Lunate bone | definition of lunate bone by Medical dictionary Lunate bone | definition of lunate bone by Medical dictionary Related to lunate bone: triquetral bone , trapezoid bone lunate bone n. The second of three bones forming the proximal row of bones in the wrist. Also called semilunar bone. lunate bone [lo̅o̅′nāt] Etymology: L, luna, moon; AS, ban the carpal bone in the center of the proximal row of carpal bones between the scaphoid and triangular bones.

It articulates with five bones, the radius proximally, the capitate and the hamate distally, the scaphoid laterally, and the triangular medially. Also called os lunatum, semilunar bone . lu·nate bone (lū'nāt bōn) One of the proximal row in the carpus between the scaphoid and triquetral; it articulates with the radius, scaphoid, triquetral, hamate, and capitate. bone (bon) 1. Osseous tissue, a specialized form of dense connective tissue consisting of bone cells (osteocytes) embedded in a nonliving matrix. Bone matrix is made of calcium carbonate, calcium phosphate, and collagen fibers. Synonym: os. PARTS OF A LONG BONE 2. A unit of the skeleton; the human skeleton has 206 bones. Bones surround and protect some vital organs, and give points of attachment for the muscles, serving as levers and making movement possible. In the embryo, the bones of the skull are first made of fibrous connective tissue, which is gradually replaced by bone matrix.

The remainder of the skeleton is first made of hyaline cartilage, which is also replaced by bone matrix, beginning during the third month of gestation. The outer surface of a bone is compact bone, and the inner more porous portion is cancellous (spongy) bone. The shafts of long bones are made of compact bone that surrounds a marrow canal. Compact bone is made of haversian systems, which are precise arrangements of osteocytes, blood vessels, and lymphatics within the bony matrix. All of these contribute to the maintenance and repair of bone. The periosteum is the fibrous connective tissue membrane that covers a bone. It has blood vessels that enter the bone, and it provides a site of attachment for tendons and ligaments. Bones are classified according to shape as long, short, flat, or irregular. In the elderly, esp. women, osteoporosis may develop, a condition in which bones become brittle and break easily. See: illustration; skeleton for names of principal bones alveolar bone HYOID BONE hyoid bone The horseshoe-shaped bone at the base of the tongue.

It is mobile and its ends hang by the stylohyoid ligaments from the styloid process on each side of the base of the skull. The hyoid bone is suspended by many muscles (the hyoid muscles): the suprahyoid muscles (geniohyoid, mylohyoid, digastric, and hyoglossus) attach the hyoid bone to the mandible and the floor of the mouth; the infrahyoid muscles (omohyoid, sternohyoid, and thyrohyoid) attach it to the larynx and the thoracic cage. The hyoid bone anchors and moves with the jaw, tongue, pharynx, and larynx. See: illustration Crescent-shaped bone of the carpus. Synonym: lunate bone sesamoid bone A type of short bone occurring in the hands and feet and embedded in tendons or joint capsules. Soemmering's bone See: Soemmering's bone sphenoid bone The large bone at the base of the skull that has the ethmoid bone in front of it, the occipital bone behind it, and the parietal and temporal bones at the sides. It is shaped like a large moth.

Its two broad, curved wings form the front walls of the middle cranial fossae, and its two “tails, ” the pterygoid processes, which hang in front of the neurocranium in the pterygoid fossa behind the facial skeleton. Between the wings, in the center of the body of the sphenoid bone, there is a deep, concave pocket (the sella turcica), in which the pituitary gland lies. spongy bone Lunate Bone | Colorado PROFILES View in: PubMed del Piñal F, Klausmeyer M, Thams C, Moraleda E, Galindo C. Arthroscopic resection arthroplasty for malunited intra-articular distal radius fractures. J Hand Surg Am. 2012 Dec; 37(12):2447-55. View in: PubMed Bleuler P, Shafighi M, Donati OF, Gurunluoglu R, Constantinescu MA. Dynamic repair of scapholunate dissociation with dorsal extensor carpi radialis longus tenodesis. J Hand Surg Am.

2008 Feb; 33(2):281-4. View in: PubMed Sakryd G, Wolf R. Case of the month. Radial styloid fracture with scapholunate ligamentous injury. JAAPA. 2006 Apr; 19(4):76. View in: PubMed Hogan CJ, McKay PL, Degnan GG. Changes in radiocarpal loading characteristics after proximal row carpectomy. J Hand Surg Am. 2004 Nov; 29(6):1109-13. View in: PubMed Wolfe SW, Neu C, Crisco JJ. In vivo scaphoid, lunate, and capitate kinematics in flexion and in extension. J Hand Surg Am. 2000 Sep; 25(5):860-9. Hand Bones | Carpal Bones | Learn Bones Scaphoid The scaphoid bone is one of the wrist bones, found in each hand. The scaphoid bone is slightly larger than the other carpal bones and lies near the thumb. It consists of seven surfaces: superior, inferior, dorsal, volar, lateral, medial, and distal convex surfaces.

The scaphoid plays an important role in wrist movement and support. Interestingly, the scaphoid's name is derived from the Greek word skaphe, meaning boat. Lunate The lunate bone, also known as the semilunar bone, is a crescent shaped bone of the wrist. The lunate is found on each hand and thus accounts for 2 bones of the human body skeleton. It lies between the scaphoid and triquertal bone and consists of six surfaces: superior and medial surfaces Pisiform The pisiform bone, also known as the lentiform bone, is a small bone found in the wrist or carpal region. Unlike many other carpal bones, the pisiform bone is a sesamoid bone since it is located within a tendon. Like other carpal bones, the pisiform aids in motility and support. The origin of the pisiform is the latin word pisum, meaning "pea" since the pisiform is shaped somewhat like a pea. Additionally, the pisiform bone consists of the dorsal, palmar, lateral, and medial surfaces. The pisiform is found in each wrist of the arm.

Trapezium The trapezium bone is a carpal bone and accounts for two bones of the human body skeleton. This bone is quadrilateral in shape and like the other carpal bones, functions in motility and support. The trapezium articulates with the scaphoid bone. Additionally, the trapezium consists of the superior Often, the hamate bone fractures in sports related injuries. Additionally, the hamate's name is derived from the Latin word hamatus, meaning hooked. Metacarpal Bones Each hand consists of five metacarpal bones and thus the entire human skeleton consists of ten metacarpal bones. The metacarpal bones are located in the metacarpus (palm region). They lie in between the carpus and the phalanges (fingers). The metacarpal bones primary functions include hand motion, hand support, and providing the shape of the hand. (Diagram of the metacarpal bones is shown at the top of the page). The Phalanges consist of three sections; The proximal phalanges, the intermediate phalanges, and the distal phalanges. Collectively, these bones make up the structure known as the fingers.

(Diagram of the phalanges is shown at the top of the page). Proximal Phalanges The proximal phalanges are found at the base of the fingers, closest to the carpus. These bones are longer than the carpal bones and play an important role in motion. Intermediate Phalanges The intermediate phalanges are found in between the proximal phalanges and distal phalanges. There are four intermediate phalanges found on each hand, the only fingers that lacks the intermediate phalanges are the thumbs. Like the distal phalanges, the intermediate phalanges plays an important role in motion and support of the hand. Distal Phalanges The distal phalanges are a series of bones found at the tip of the hand, following the intermediate phalanges. The distal phalanges consists of five bones per hand and thus contribute a total of ten bones to the human skeleton. These bones play an important role in movement and functions of the hand. CLICK HERE for more detailed information on the hand bones. Triquetrum Bone Anatomy, Function & Diagram | Body Maps Your message has been sent. OK We're sorry, an error occurred.

We are unable to collect your feedback at this time. However, your feedback is important to us. Please try again later. Close Triquetrum The triquetrum refers to a part of the wrist known as the triquetral bone. Specifically, the bone is part of the carpus, a group of eight wrist bones. The triquetrum and other bones in the carpus are located between the two major bones in the forearm, the radius and ulna. The triquetral bone is situated between two carpal bones known as the lunate and pisiform. It is partly covered by the pisiform bone. The triquetrum is found right above the end of the ulna bone. Its functional ability is not dependent on the ulna bone. It acts in tandem with the pisiform carpal bone and the ulnar collateral ligament. The triquetrum is pyramidal in shape, with five different sections designated on three distinct sides of the bone. The triquetral bone is the third most common site of carpal bone fractures. Triquetrum fractures are especially common amongst those who play sports. Fractures generally occur when the wrist is overextended.

A small portion of the bone may be chipped off, or the fracture can run through the middle of the bone. Kienbock's Disease | Orthogate Kienbock's Disease Published: 20 July 2006 Introduction Kienbock's disease is a condition in which one of the small bones of the wrist loses its blood supply and dies, causing pain and stiffness with wrist motion. In the late stages of the disease, the bone collapses, shifting the position of other bones in the wrist. This shifting eventually leads to degenerative changes and osteoarthritis in the joint. While the exact cause of this uncommon disease isn't known, a number of treatment options are available. This guide will help you understand how Kienbock's disease develops how doctors diagnose the condition what treatment options are available Anatomy How does the wrist joint work? The anatomy of the wrist joint is extremely complex, probably the most complex of all the joints in the body. The wrist is actually a collection of many joints and bones. These joints and bones let us use our hands in lots of different ways. The wrist must be extremely mobile to give our hands a full range of motion.

At the same time, the wrist must provide the strength for heavy gripping. The wrist is made of eight separate small bones, called the carpal bones. The lunate is one of these bones. It is the bone that is affected in patients with Kienbock's disease. The carpal bones connect the two bones of the forearm , the radius and the ulna, to the bones of the hand. The metacarpal bones are the long bones that lie underneath the palm. The metacarpals attach to the phalanges, which are the bones in the fingers and thumb. Causes Why do I have this condition? Doctors have not determined exactly what causes Kienbock's disease. A number of factors seem to be involved. Usually the patient has injured the wrist. The injury may be a single incident, such as a sprain, or a repetitive trauma. But the injury alone does not seem to cause the disease. The way that blood vessels supply the lunate is thought to play a role in Kienbock's disease. Some bones in the body simply have fewer blood vessels that bring in blood. The lunate is one of those bones.

A bone with a limited blood supply may be more at risk of developing the disease after an injury. The reduced blood supply might be the result of a previous injury to the blood vessels. Other bones around the lunate may play a role in the disease, too. The length of the ulna , the bone of the forearm on the opposite side of the thumb, may be a factor. When the ulna is shorter than the radius, the lunate bone absorbs more force when the wrist is used for heavy gripping activities. Over time, this extra force may make it more likely for a person to develop Kienbock's disease. The extra forces make a person more likely to injure the lunate or the blood vessels around it as a result. Kienbock's disease is also sometimes found in people with other medical conditions that are known to damage small blood vessels of the body. Whatever the cause, the lunate bone develops a condition called osteonecrosis . In osteonecrosis, the bone dies, usually because it's not getting enough blood. Symptoms What does Kienbock's disease feel like? The primary symptoms of Kienbock's disease are pain in the wrist and limited wrist motion.

Pain may vary from slight discomfort to constant pain. In the early stages there may be pain only during or after heavy activity using the wrist. The pain usually gets slowly worse over many years. The wrist may swell. The area over the back of the wrist near the lunate bone may feel tender. You may not be able to move your wrist as much as normal or grip objects as well. Patients often have the condition for months or years before seeking treatment. Typically, the patient will report an injury to the wrist in the past or have a history of repetitive heavy use of the wrist. Kienbock's disease most frequently affects men 20 to 40 years old. It rarely affects both wrists. Diagnosis How do doctors identify the problem? Your doctor will begin by taking a detailed history of the problem and examining the wrist. X-rays and possibly a magnetic resonance imaging (MRI) scan will be ordered. The X-rays are useful to determine how far the disease has advanced. This helps your doctor plan treatment. The MRI machine uses magnetic waves instead of radiation to take a series of pictures that look like slices of the wrist. The MRI scan is most useful if your doctor is not sure whether the lunate bone has lost its blood supply.

The MRI is extremely accurate at showing whether a bone has a blood supply or not. Changes in the lunate bone will usually appear on one of these tests. No other tests are usually required. Treatment What can be done for the condition? Kienbock's disease usually progresses slowly over many years. To help understand it and recommend what treatment is best, hand surgeons divide the progression of the disease into four stages. Stage one: The bone loses its blood supply, and a fracture of the lunate may occur. Stage two: The bone hardens (called sclerosis) because of the lack of blood supply. Stage three: The dead lunate bone collapses. It may break into several pieces and move out of its normal position. Stage four: The surfaces of the nearby wrist bones are damaged, resulting in arthritis of the wrist. Treatment is determined by what stage the disease is in. Nonsurgical Treatment Stage one Kienbock's disease is usually treated using nonsurgical treatments. Doctors may suggest immobilizing the wrist in a cast for up to three months. It is possible that the blood supply to the lunate will return and the disease will clear up during this time.

If the patient has what's known as transient (meaning short-lived) osteonecrosis rather than true Kienbock's disease, the condition may also clear up during this time. Transient osteonecrosis sometimes develops briefly after an injury. Surgery Revascularization Stage two and stage three Kienbock's disease often require surgery when immobilizing the wrist doesn't help. Attempts to restore the blood flow to the lunate are most likely to be successful at this point. The procedure to restore blood flow is called revascularization . During the operation, the surgeon moves a small section of blood vessels (and also possibly bone) from elsewhere on the patient. The segment is attached to the deteriorating lunate bone. This is done to restore blood flow to the lunate and halt its deterioration. This is a newer procedure to treat Kienbock's disease and is not always successful. Arthroscopy and Fusion Using an arthroscope, a thin instrument with a TV camera on the end, surgeons are able to operate using a small incision over the lunate. The surgeon cleans the area around the lunate, and then fuses the lunate to the carpal bone next to it.

Bringing an extra blood vessel to revascularize the lunate (described above) is not necessarily a part of the treatment. Lunate Decompression Other treatment options at this stage include operations designed to take some of the pressure off (decompress) the lunate bone. Doing this may allow the bone to heal and revascularize, or it may at least slow the progression of the disease. Operations to do this include a radial shortening osteotomy . In this operation, removing a small section of the bone near the wrist shortens the radius bone, allowing the bone to heal together in this shortened position. Capitate Shortening Some surgeons prefer a capitate shortening (known as the Almquist procedure), which shortens a carpal bone on the other side of the lunate. Lunate decompression and capitate shortening are both helpful for reducing the force on the lunate. Carpectomy In stage four (late-stage) Kienbock's disease, surgeons focus on treating the wrist osteoarthritis that results when the lunate collapses and dies. One surgical option at this stage is proximal-row carpectomy. Carpectomy means excision (removal) of one or more of the carpal bones.

The wrist is made up of two rows of carpal bones, four in each row. The lunate is in the proximal row (the row closest to the forearm). When the lunate has collapsed, but the wrist joint is not terribly arthritic, the four carpal bones of the proximal row may simply be removed. This allows the distal row (the other four bones) to slide down a bit and to begin moving against the forearm bones instead. The wrist joint seems to work pretty well after this procedure. The advantage is that you will still have a good deal of wrist motion, unlike wrist fusion (described below). A proximal row carpectomy is a good solution when you need a flexible wrist more than you need a strong one, such as in someone who plays piano for a living. During this procedure, the surgeon can also take out a section of the nerve that supplies feeling to the wrist joint to reduce wrist pain. This will not affect the feeling in your hand, because it only affects the nerve that goes to the wrist joint itself, below the skin level. Wrist Fusion Finally, your surgeon may also suggest a wrist fusion when the entire wrist has become arthritic.

(A wrist fusion is sometimes called an arthrodesis of the wrist). A fusion is an operation that allows all the bones of the wrist to grow together to form one bone. This makes the wrist stiff. You will not be able to bend the wrist after a fusion. You will be able to turn the wrist palm up and palm down. A fusion is a good solution when you need a strong wrist more than you need wrist movement, such as someone who does manual labor. What is Kienbock's disease and how is it caused? - Medical News Today What is Kienbock's disease and how is it caused? Written by Christian Nordqvist Kienbock's disease, also known as avascular necrosis of the lunate, occurs when one of the eight small carpal bones in the wrist - the lunate bone - becomes damaged because its blood supply is lost. Kienbock's disease is a rare, debilitating disease process that can lead to chronic pain and dysfunction. In the Journal of Hand Surgery 1, avascular necrosis of the lunate is also referred to as "osteonecrosis of the lunate". Avascular necrosis means death, damage or fracture of bone tissue due to interruption of blood supply.

Without an adequate blood supply, bone death or damage (osteonecrosis) can occur. Robert Kienböck (1871-1953), an Austrian radiologist and pioneer in the use of x-ray technology for medical diagnosis and therapy, described a disorder in which the lunate bone in the wrist would break down. Kienböck called the disorder "lunatomalacia". He published his findings in a dissertation titled "Traumatic malacia of the lunate and its consequences" (Über traumatische Malazie des Mondbeins und ihre Folgezuständ). The disorder was later called "Kienbock's disease". The disease may be spelled "Kienböck's" or "Kienbock's". The carpal bones in the wrist In Kienbock's disease one of the carpal bones - the lunate - becomes damaged. The carpal bones consist of eight wrist bones that connect the hand to the forearm. These bones facilitate flexible positioning of the hand. The Lunate is one of the 8 bones in the carpus The lunate bone is crucial for proper movement and support of the joint.

If the lunate bone is damaged, the patient may experience stiffness and pain, and eventually arthritis of the wrist. What are the signs and symptoms of Kienbock's disease? According to the National Institutes of Health 2, at first, affected people may wonder whether they have sprained their wrist. However, in the case of Kienbock's disease the signs and symptoms do not go away - it is a progressive disease. Kienbock's disease progresses differently from patient-to-patient. Generally, it develops slowly and subtly over a period of many years. Initially, the patient might only experience pain and swelling. Later on the mechanics of the wrist become affected. This places abnormal stresses and wear inside the wrist. According to the American Society for Surgery of the Hand 3, Kienbock's diseases has four stages: Stage 1 - the lunate has lost its blood supply. However, x-rays are unable to detect anything abnormal with the affected bone. There is some pain, possibly some swelling as well, and a risk of fracture. Stage 2 - x-rays show that the bone is unusually dense. When bone loses its blood supply it hardens. Stage 3 - the bone starts to shatter (fragments and collapses).

Stage 4 - the lunate has completely collapsed. The other bones next to the lunate have also become damaged and arthritic. No all patients reach this stage. The following signs and symptoms are common in Kienbock's disease: swollen wrist stiffness in the wrist - the range of motion becomes progressively limited clicking or clunking in the wrist weaker grip strength tenderness directly over the lunate bone difficulty in turning the hand upward pain when trying to turn the hand upward What are the causes of Kienbock's disease? Experts believe Kienbock's disease does not have a single cause, and is the result of multiple factors. According to Massachusetts General Hospital 4, the following factors are associated with a higher risk of developing Kienbock's disease: Problems with blood supply (arteries). Most of us have two blood vessels supplying blood to the lunate bone. However, in some cases there is just one source. Problems with blood drainage (veins). Skeletal variations - possibly the lunate bone has an abnormal shape. The ulna, one of the bones in the forearm may be shorter than normal.

If the ulna and radius bones are different lengths there may be extra pressure on the lunate in certain wrist motions - this extra stress could eventually lead to Kienbock's disease. Some diseases may be linked to a greater risk, including lupus , cerebral palsy , sickle cell anemia and gout . One study found that 9.4% of cerebral palsy patients also had Kienbock's disease 5. Trauma - blood supply may have been affected by a single blow, as in a car accident, or "repeated significant trauma". There is no compelling evidence suggesting that certain jobs may increase the risk of developing Kienbock's disease How is Kienbock's disease diagnosed? Most patients do not come to see a doctor until the symptoms start bothering them. In the majority of cases, this means they have been living with the progressive disease for several months, and even years. Most patients will initially present with wrist pain. The doctor will ask questions about the symptoms, medical history, whether there has been any serious trauma, and how long symptoms have been present. The patient's hand and wrist will be examined.

At first, Kienbock's disease may be difficult to diagnose accurately, because its signs and symptoms are similar to those found in many other conditions, such as wrist sprain and any cause of arthritis. Even x-ray imaging during Stage 1 of the disease will show an apparently normal lunate bone. Magnetic Resonance Imaging ( MRI ) can help the doctor assess the blood supply to the lunate. CT (computed tomography) scanning may be used in later stages to determine the number and sizes of the lunate fragments. Even if the x-ray does not show any bone abnormality and the doctor does not order further MRI or CT scans , the x-rays will later pick up the signs when the bone starts to harden 6 and lose its mineral content. What are the treatment options for Kienbock's disease? Treatment usually depends on how early on the disease is diagnosed. Non-surgical options for Kienbock's disease Resting the wrist - if it is diagnosed early enough, it might be possible to splint and cast the wrist for several weeks. Resting the wrist increases the likelihood of restoring blood flow to the lunate bone. However, this is only an option during Stage 1.

Anti-inflammatory drugs, such as ibuprofen or aspirin may help manage the symptoms of swelling and pain during the early stages. Wrist injection with a cortisone type solution may also help symptoms. Close monitoring of symptoms is important during Stage 1. If OTC (over-the-counter, no prescription required) anti-inflammatory medications start becoming less effective, the doctor may recommend surgery. A specialized physical therapist can teach the patient "activity modification" - how to use the wrist in a way that is less painful and slows down the progression of the disease. Surgical procedures for Kienbock's disease There are several different surgical procedures available for patients with Kienbock's disease. Which one chosen to recommend will depend on several factors. According to the American Academy of Orthopaedic Surgeons 7, these options usually depend on the stage of the disease, the patient's level of activity, the patient's personal goals and how experienced the surgeon is. External fixator used in orthopaedic surgery Revascularization - this means either restoring or augmenting the blood supply, which in this case is to the lunate bone. Revascularization is an option during Stages 1 and 2, before the bone has deteriorated significantly.

The surgeon removes a portion of bone with all its attached blood vessels from another bone and inserts it into the lunate bone. The portion of bone with that is attached is called a "vascularized graft". The surgeon may temporarily apply an external fixator to make sure the bones stay in place while they heal. An external fixator is a metal device which is attached to the outside of the wrists, with pins that insert into the bone. Joint leveling - an option when the two bones - radius and ulna - of the forearm have different lengths. Either bone grafts are applied to lengthen bone, or a section of bone is removed to shorten it. Joint leveling often stops the disease from progressing by reducing the forces that compress the lunate bone. Proximal row carpectomy (PRC) - the removal of the lunate bone. An option if the bone is broken into pieces or severely collapsed. The surgeon also removes the two bones on either side of the lunate. The Hand and Wrist Center of Houston 8, Texas, explains the pros and cons of PRC. Advantage - PRC is straightforward surgical procedure.

Disadvantage - "The two new bones that rub together do not match and arthritis develops where they make contact." Fusion - this can be partial or complete fusion. In partial fusion some of the wrist bones are fused together, effectively becoming one solid bone. The aim here is to reduce symptoms of pain and maintain some wrist motion. If the patient has severe arthritis of the wrist, the doctor may recommend fusing all the bones. The result will be much less pain and better hand function. Even though wrist motion will be completely lost, the patient is still able to rotate the forearm. When the bones are fused, the result will last for the rest of the patient's life. Implant arthroplasty - the lunate bone is replaced with a prosthetic replica made of a special, durable, pyrolytic carbon material. According to the Hand and Wrist Center of Houston, this procedure preserves the normal anatomy of all the others bones. As this procedure is relatively new in this part of the body, nobody knows what the long-term results of this treatment are. Some patients may undergo several different procedures during their lifetime. Possibly starting off with casting, then a bone graft, radial shortening, proximal row carpectomy and finally wrist fusion.

What are the complications associated with Kienbock's disease? If left untreated, the patient will experience progressive deterioration of the wirst, loss of wrist function and increasing pain. Between Stages 2 and 4 of the disease, grip strength deteriorates by 40%. Researchers from Shinshu University School of Medicine, Japan, wrote in the Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery 9 that "Closed tendon rupture is a well-known complication of Kienbock disease." Written by Christian Nordqvist Click the stars to rate this article What is Kienbock's disease and how is it caused? Public / Patient Kienbock's Disease | Houston Methodist Kienbock's Disease A Patient's Guide to Kienbock's Disease Introduction Kienbock's disease is a condition in which one of the small bones of the wrist loses its blood supply and dies, causing pain and stiffness with wrist motion. In the late stages of the disease, the bone collapses, shifting the position of other bones in the wrist. This shifting eventually leads to degenerative changes and osteoarthritis in the joint. While the exact cause of this uncommon disease isn't known, a number of treatment options are available.

This guide will help you understand how Kienbock's disease develops how doctors diagnose the condition what treatment options are available Anatomy How does the wrist joint work? The anatomy of the wrist joint is extremely complex, probably the most complex of all the joints in the body. The wrist is actually a collection of many joints and bones. These joints and bones let us use our hands in lots of different ways. The wrist must be extremely mobile to give our hands a full range of motion. At the same time, the wrist must provide the strength for heavy gripping. The wrist is made of eight separate small bones, called the carpal bones. The lunate is one of these bones. It is the bone that is affected in patients with Kienbock's disease. The carpal bones connect the two bones of the forearm , the radius and the ulna, to the bones of the hand. Themetacarpal bones are the long bones that lie underneath the palm. The metacarpals attach to the phalanges,which are the bones in the fingers and thumb. Causes Why do I have this condition? Doctors have not determined exactly what causes Kienbock's disease. A number of factors seem to be involved.

Usually the patient has injured the wrist. The injury may be a single incident, such as a sprain, or a repetitive trauma. But the injury alone does not seem to cause the disease. The way that blood vessels supply the lunate is thought to play a role in Kienbock's disease. Some bones in the body simply have fewer blood vessels that bring in blood. The lunate is one of those bones. A bone with a limited blood supply may be more at risk of developing the disease after an injury. The reduced blood supply might be the result of a previous injury to the blood vessels. Other bones around the lunate may play a role in the disease, too. The length of the ulna , the bone of the forearm on the opposite side of the thumb, may be a factor. When the ulna is shorter than the radius, an imbalance of pressure is created in the wrist joint. Normally, the ulna supports a portion of the force that needs to be transferred from the hand to the forearm. If the ulna is too short, this cannot occur. The lunate is caught between the capitate bone and the radius and must absorb more force when the hand is used for heavy gripping activities.

Over time, this extra force may make it more likely for a person to develop Kienbock's disease. Chronic repetitive trauma can lead to damage of the arteries supplying blood to the lunate. Kienbock's disease is also sometimes found in people with other medical conditions that are known to damage small blood vessels of the body. Whatever the cause, the lunate bone develops a condition called osteonecrosis . In osteonecrosis, the bone dies, usually because it's not getting enough blood. Symptoms What does Kienbock's disease feel like? The primary symptoms of Kienbock's disease are pain in the wrist and limited wrist motion. Pain may vary from slight discomfort to constant pain. In the early stages there may be pain only during or after heavy activity using the wrist. The pain usually gets slowly worse over many years. The wrist may swell. The area over the back of the wrist near the lunate bone may feel tender. You may not be able to move your wrist as much as normal or grip objects as well. Patients often have the condition for months or years before seeking treatment. It rarely affects both wrists. Without treatment the bone may collapse.

When the lunate bone is displaced or fragmented, it can rub on the tendons that slide along the back of the wrist - the extensor tendons. The abnormal bone may eventually wear through one or more of the extensor tendons along the back of the wrist. The wrist becomes unstable. The resulting misalignment causes even more uneven wear on the bones leading to osteoarthritis between the radius and the carpal bones. Diagnosis How do doctors identify the problem? Your doctor will begin by taking a detailed history of the problem and examining the wrist. X-rays and possibly a magnetic resonance imaging (MRI) scan will be ordered. The X-rays are useful to determine how far the disease has advanced. This helps your doctor plan treatment. The MRI machine uses magnetic waves instead of radiation to take a series of pictures that look like slices of the wrist. The MRI scan is most useful if your doctor is not sure whether the lunate bone has lost its blood supply. The MRI is extremely accurate at showing whether a bone has a blood supply or not. Changes in the lunate bone will usually appear on one of these tests. No other tests are usually required. Treatment What can be done for the condition?

Kienbock's disease usually progresses slowly over many years. To help understand it and recommend what treatment is best, hand surgeons divide the progression of the disease into four stages. Stage one: The bone loses its blood supply, and a fracture of the lunate may occur. Stage two: The bone hardens (called sclerosis) because of the lack of blood supply. Stage three: The dead lunate bone collapses. It may break into several pieces and move out of its normal position. Stage four: The surfaces of the nearby wrist bones are damaged, resulting in arthritis of the wrist. Related Document: A Patient's Guide to Osteoarthritis of the Wrist Joint The goal of treatment is to decrease the load across the lunate and/or bring a better blood supply to it. Treatment is determined by what stage the disease is in. Staging can be difficult since the degenerative changes occur slowly over a long period of time. Repeated imaging studies may be needed to confirm earlier suspicious findings. There is no strong evidence at this time to suggest one treatment works better than another. The physician looks at all the factors and makes the best clinical judgment possible. Your age, occupation, activity level, and findings from the diagnostic process will all be taken into consideration.

Nonsurgical Treatment Stage one Kienbock's disease is usually treated using nonsurgical treatments. Doctors may suggest immobilizing the wrist in a cast for up to three months. It is possible that the blood supply to the lunate will return and the disease will clear up during this time. If the patient has what's known as transient (meaning short-lived) osteonecrosis rather than true Kienbock's disease, the condition may also clear up during this time. Transient osteonecrosis sometimes develops briefly after an injury. Surgery Operative treatment can be broken down into several major categories, including 1) revascularization 2) intercarpal fusion; 3) lunate excision; 4) lunate decompression and joint-leveling procedures; 5) proximal row carpectomy; and 6) wrist fusion. Revascularization Stage two and stage three KienbÃ¶ck's disease often require surgery when immobilizing the wrist doesn't help. Attempts to restore the blood flow to the lunate are most likely to be successful when the disease is in the early stages. The procedure to restore blood flow is called revascularization .

During the operation, the surgeon moves a small section of blood vessels (and also possibly bone) from elsewhere on the wrist. The segment is attached to the deteriorating lunate bone. This is done to restore blood flow to the lunate and halt its deterioration. This is a newer procedure to treat KienbÃ¶ck's disease and is not always successful. Vascularized bone graft does have the advantage of implanting live bone with a ready made blood supply.If this is successful, the bone heals and the blood supply in the transferred bone fragment grows into the rest of the lunate to restore the blood supply to the entire lunate. Intercarpal Fusion Using an arthroscope, a thin instrument with a TV camera on the end, surgeons are able to operate using a small incision over the lunate. The surgeon cleans the area around the lunate, and then fuses the lunate to the carpal bone next to it. This is called an intercarpal fusion. It's not a complete or total fusion because not all of the wrist bones are fused together. Bringing an extra blood vessel to revascularize the lunate (described above) is not necessarily a part of the treatment.

Lunate Excision One of the oldest methods for treating Kienbock's disease is called a lunate excision. The abnormal bone was just removed, leaving an empty space in the wrist joint. The bones in the area collapsed into the empty space. This usually was not ideal and created problems later on. Other options include filling the empty space with a piece of tendon coiled up and stuffed into the hole. An artificial lunate bone may also be used to fill this space and maintain alignment of the bones. Lunate Decompression and Joint Leveling If you were born with an ulna that is too short, you have what is called an ulna minus wrist joint. As described above, this can lead to increased pressure on the lunate and may be contributing to the problem. Your surgeon may recommend a joint leveling procedure to reduce the pressure on the lunate. Doing this may allow the bone to heal and revascularize, or it may at least slow the progression of the arthritis in the joint. A joint leveling operation either shortens the bone that is too long ( the radius) or lengthens the bone that is too short (the ulna). Joint leveling operations include ulnar lengthening and radial shortening osteotomy.

Ulnar Lengthening The operation for ulnar lengthening is done by making a small incision on the ulnar side of the wrist. The ulna bone is cut. Osteotomy is the term surgeons use to describe cutting a bone. The bone is not cut straight across, but like a stair step. This allows the surgeon to slide the two ends of the bone apart about 1/4 or 1/2 inch and still have the bone overlapping and connected. This type of cut prevents ending up with a large gap between the two segments of bone that can delay or prevent healing. The surgeon will slide the two segments of ulna apart until X-rays show the joint is level and the radius and ulna are of equal length. The two segments of bone are held in place with a small metal plate and screws until they heal together. The plate may be removed once the bone heals. Radial Shortening Osteotomy If your surgeon suggests a radial shortening osteotomy, then the goal is to shorten the bone that is too long. A radial osteotomy is sometimes preferred because the bone just heals better. The distal end of the radius near the wrist joint is larger than the ulna with a better blood supply.

This means that it heals faster and more reliably. To perform the radial osteotomy, the surgeon makes a small incision though the skin over the end of the radius. Before the operation, the surgeon uses the X-rays and measures how much bone must be removed to make the joint level. The radius is cut completely in two pieces and a small section, or wedge, of the bone near the wrist is removed. The two segments of the shortened radius are aligned and held in place with a metal plate and screws until healed. Some studies show this method has a lower rate of complications and good outcomes. It is used more often than ulnar lengthening. Stage two Kienbock's disease and wrists in stage three that are stable can be treated with joint leveling procedures. Decreased pain with improved range of motion and strength are possible with joint leveling. But getting the exact length needed can be difficult. Capitate Shortening Some surgeons prefer a capitate shortening (known as the Almquist procedure), which shortens a carpal bone on the other side of the lunate. Lunate decompression and capitate shortening are both helpful for reducing the force on the lunate. This procedure does not level the joint.

Carpectomy In stage four (late-stage) Kienbock's disease, surgeons focus on treating the wrist osteoarthritis that results when the lunate collapses and dies. One surgical option at this stage is proximal-row carpectomy. Carpectomy meansexcision (removal) of one or more of the carpal bones. The wrist is made up of two rows of carpal bones, four in each row. The lunate is in the proximal row (the row closest to the forearm). When the lunate has collapsed, but the wrist joint is not terribly arthritic, the four carpal bones of the proximal row may simply be removed. This allows the distal row (the other four bones) to slide down a bit and to begin moving against the forearm bones instead. The wrist joint seems to work pretty well after this procedure. The advantage is that you will still have a good deal of wrist motion, unlike wrist fusion (described below). A proximal row carpectomy is a good solution when you need a flexible wrist more than you need a strong one, such as in someone who plays piano for a living.

During this procedure, the surgeon can also take out a section of the nerve that supplies feeling to the wrist joint to reduce wrist pain. This will not affect the feeling in your hand, because it only affects the nerve that goes to the wrist joint itself, below the skin level. Wrist Fusion Finally, your surgeon may also suggest a wrist fusion when the entire wrist has become arthritic. (A wrist fusion is sometimes called an arthrodesis of the wrist). A fusion is an operation that allows all the bones of the wrist to grow together to form one bone. This makes the wrist stiff. You will not be able to bend the wrist after a fusion. You will be able to turn the wrist palm up and palm down. A fusion is a good solution when you need a strong wrist more than you need wrist movement, such as someone who does manual labor. What should I expect after treatment? Nonsurgical Rehabilitation If the bone is in good alignment, you may be placed in a cast for up to 12 weeks. This amount of time is needed to allow the blood supply to return to the bone. When your doctor is certain the bones have healed, your cast will be removed. Your wrist will probably be stiff and weak from being in the cast.

You may need physical or occupational therapy for four to six weeks to help improve wrist range of motion and strength. After Surgery You'll be placed in a splint for about 12 weeks after surgery. Your surgeon will X-ray the wrist several times after surgery to make sure that the bones are healing properly. Once your wrist has begun to heal, you can safely begin a rehabilitation program. After surgery, you may need physical or occupational therapy sessions for eight to 12 weeks. The first few treatments will focus on controlling the pain and swelling. You will work into doing exercises to help strengthen and stabilize the muscles around the wrist joint. Other exercises are used to improve fine motor control and dexterity of your hand. You'll be given tips on ways to do your activities while avoiding extra strain on the wrist joint. *Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

All content provided by eORTHOPOD® is a registered trademark of Medical Multimedia Group, L.L.C. . Content is the sole property of Medical Multimedia Group, LLC and used herein by permission. Arthritis of the Wrist-OrthoInfo - AAOS Copyright 2016 American Academy of Orthopaedic Surgeons Arthritis of the Wrist Arthritis involves inflammation of one or more of your joints. Pain and stiffness are common symptoms of arthritis, and when these occur in your wrist, simple daily activities can become more difficult. There are many types of arthritis, and most of these can affect the wrist. Although the severity of symptoms related to arthritis can vary, most arthritis-related diseases are chronic. This means that they are long-lasting—even permanent—and can eventually cause serious joint damage. Your wrist is a complex joint—it is actually made up of multiple small joints. When healthy, the bones glide easily over each other during movement, protected by smooth cartilage that coats the joint surfaces. Arthritis damages this cartilage. As the disease progresses, there is a gradual loss of cartilage. Without a smooth joint surface, the bones rub against each other, leading to joint damage that cannot be repaired.

Although there is no cure for arthritis today, there are many treatment options available to help relieve your symptoms. Some options may also slow the progression of joint damage. With proper treatment, many people are able to manage their symptoms and stay active. The bones of the wrist. Cartilage coats the ends of the bones to create a gliding joint. Reproduced from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010. Anatomy The wrist is a complex joint that connects the hand to the forearm. It is formed by the two bones of the forearm—the radius and the ulna—and eight small carpal bones. The carpal bones are arranged in two rows at the base of the hand. There are four bones in each row. The joint surface of each bone is covered with articular cartilage—a slippery substance that protects and cushions the bones as you move your hand and wrist. Top of page Treatment There is no cure for arthritis, but there are a number of treatments that may help reduce the frequency of your symptoms and relieve the pain and loss of function it can cause.

Nonsurgical Treatment In general, initial treatment for arthritis is nonsurgical in nature and designed to help minimize your symptoms. Nonsurgical treatment options may include: Activity modification. Limiting or stopping the activities that make your pain worse is the first step in relieving symptoms. Immobilization. Wearing a wrist splint for a short time will help support the joint and ease the stress placed on it by frequent use and activities. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, naproxen, and ibuprofen can help reduce both pain and swelling. Topical NSAIDs can be applied directly to the skin in the area of the joint. Exercise. Specific exercises will help improve range of motion and function in your wrist. Your doctor or a physical therapist can help develop an exercise program that meets your specific needs. Steroid injection. Cortisone is a powerful anti-inflammatory agent that can be injected into an arthritic joint. Although an injection of cortisone can provide relief and reduce inflammation, the effects may be temporary. Other therapies. This may include using "contrast soaks" of warm and cold water to help reduce swelling.

If your symptoms of rheumatoid arthritis are not adequately controlled by the above therapies, your doctor may prescribe additional medications. These medications—called disease-modifying anti-rheumatic drugs (DMARDs)—are designed to stop the immune system from attacking the joints. Like all medications, DMARDs have both risks and benefits. Your use of DMARDs will be directed by a rheumatologist. Surgical Treatment If nonsurgical treatment does not relieve your pain and your quality of life has been significantly affected by arthritis, your doctor may recommend surgery. The goal of surgery is to relieve pain while preserving or improving hand function. Typically, this is done by minimizing or eliminating bone-on-bone contact. There are a number of procedures for arthritis of the wrist. Your doctor will talk with you about which procedure will work best in your case. Proximal row carpectomy. In this procedure, your doctor removes three carpal bones in the row of bones that is closest to the forearm. The procedure is designed to reduce your pain while maintaining some wrist motion. (Left) The three wrist bones that are removed in a proximal row carpectomy. (Right) X-ray image of a wrist after the procedure. Fusion.

If motion is the source of your pain, your doctor may recommend fusion. Fusion is essentially a "welding" process. The basic idea is to fuse together the bones so that they heal into a single, solid bone. The theory behind fusion is that, if the painful bones do not move, they should not hurt. During the procedure, your doctor removes the damaged cartilage and then uses pins, plates, or screws to hold the joint in a permanent position. Over time, the bones fuse or grow together— similar to the way the fractured ends of a bone heal together. In some cases, your doctor can perform a partial fusion in which just some of the carpal bones are fused together. This addresses the damaged joint surfaces, but leaves the healthy joints intact to preserve some wrist motion. In this partial wrist fusion, the scaphoid bone has been removed and screws have been used to hold four carpal bones in place. If your arthritis is extensive, however, a complete wrist fusion may be necessary. In this procedure, all of the carpal bones are fused together, along with the radius (one of the bones in the forearm). Although all wrist motion is eliminated in a complete fusion, forearm rotation and finger/thumb motion are generally preserved.

In this complete wrist fusion, the bones are held together with a combination of plates, screws, and pins. Total wrist replacement (arthroplasty). In total wrist replacement, your doctor removes the damaged cartilage and bone in your wrist and then positions new metal or plastic joint surfaces to restore the function of the joint. Replacing the wrist joint relieves the pain of arthritis while allowing more wrist movement than fusion. In this total wrist replacement (arthroplasty), the worn-out bones have been replaced with an implant made of metal and plastic. Top of page Living with Arthritis It can be discouraging to learn that you have arthritis, but there are some things you can do to help lessen the impact the condition has on your life. These include: Talk to your doctor. If your symptoms worsen or you are having a hard time coping, ask your doctor to review your treatment plan and determine if changes are needed. Change your activities. If certain activities aggravate your arthritis, cut down or eliminate these activities to help minimize your symptoms. Try alternative therapies. Some alternative therapies appear to help arthritis pain. Always talk to you doctor before trying any alternative treatments as they may interfere with your overall treatment plan.

If you found this article helpful, you may also be interested in Carpal Tunnel Syndrome Carpal Tunnel Syndrome (topic.cfm?topic=A00005).

Question: Where in the body is the lunate bone
Answer: Wrist