By Amanda Garland DPT, ATC
What Is Keinbock’s Disease?
Keinbock’s disease is a condition where the blood supply to the lunate bone in the wrist becomes interrupted. If a bone does not get adequate blood supply to deliver the appropriate nutrients. Then the bone can become necrotic and die. The lunate bone is one of the eight bones in the wrist that aids with movement and support. This disease is rare and most commonly affects men between the ages of 20 and 40 years of age.
What are the causes of Keinbock’s Disease?
- Trauma is one of the most common causes for interruption of blood supply to the bones in the wrist. Trauma can include falls such as putting your arm or hand out to catch yourself. Another common cause of trauma is positioning such as having your hands on the steering wheel when involved in a motor vehicle accident.
- Bony Abnormalities can predispose a person to Keinbock’s disease. There are two bones in the forearm, known as the radius and ulna. If there is a structural abnormality, such as these bones being unequal in length, then the result may be an increase in pressure on the wrist creating a higher risk for insufficiency. Another bony abnormality that can predispose someone to this disease is an irregular shaped lunate bone.
- An Underlying Medical Condition is a third possible cause of Keinbock’s disease. This can be any condition that affects the body’s blood supply. Such conditions include: lupus, sickle cell anemia, and cerebral palsy.
Possible Symptoms Include:
- Wrist pain
- Tenderness over the lunate bone, centralized wrist bone
- Range of motion limitations
- Joint stiffness
- Decreased grip strength
How is Keinbock’s Disease Diagnosed?
A physician will perform a physical examination. This is to assess one’s joint mobility, location of pain and limitations. As well as performing a review of medical history to determine a mechanism of injury or predisposing medical condition to help rule in the possibility of the disease. However, imaging is helpful in determining a proper diagnosis. X-rays may be ordered first, but a MRI or CT scan are more reliable with identifying blood supply to the lunate. The physician can then confirm the diagnosis and identify the proper stage as well as proper treatment.
4 Stages of Keinbock’s Disease
- Stage One: The first stage is identified when the lunate initially loses the blood supply that can causing weakening of the bone. As well as being present with minor symptoms. An Xray may not be able to detect this first stage, and therefore an MRI or CT scan will be more conclusive.
- Stage Two: The second stage is identified when the lunate begins to harden as a result of the insufficient blood flow. An Xray will be able to identify this process as the bone will appear brighter.
- Stage Three: The third stage is diagnosed when the bone begins to move or break within the wrist. The symptoms at this stage may include pain, decreased grip strength, and decreased wrist mobility.
- Stage four: The final stage is noted when the bone collapses and may cause additional injury to the wrist by affecting other bones or connective tissue.
The treatment for Keinbock’s Disease is based on the time of diagnosis and dependent on the progression and stage of the disease. The treatments can include:
- Medication can be used to aid with inflammation and pain.
- Immobilization in a cast may be prescribed to decrease the pressure on the lunate.
- Surgery is required if the disease has progressed and symptoms are not able to be managed conservatively. The surgical intervention is based on the progression and amount of disease to the lunate. Surgery may be utilized to restore the blood supply in the early phases. However, in more advanced stages the lunate can be removed, fused or removed alongside additional bones to allow for recovery of mobility.
If a patient must undergo surgical intervention the physician may require the use of a splint for up to 3 to 4 months. Once a determination has been made that the bone is healing. Then physical therapy or occupational therapy can be prescribed to regain mobility and strength.
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