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Kienböck disease: death of the moonbone
If you suffer from pain in your wrist, it can be a so-called lunate malacia (lunate necrosis). As a result of insufficiently researched causes, the moonbone (Os lunatum), one of the eight carpal bones, is gradually dying. If the disease is recognized early, conservative procedures can help (temporarily) to fight the symptoms. However, manual surgery is often necessary.
Lunatum malacia - brief overview
- What is a lunate malacia? The bone disease is aseptic necrosis, which leads to the gradual death of a carpal bone (moon bone).
- How do I know if the moonbone is dying? Pain and restricted movement in the wrist are common. The disease can be recognized on X-ray or MRI images.
- Which treatment is necessary? Depending on the individual factors and stage of the disease, the wrist can first be immobilized. If this is not successful or if the disease has already progressed, a variety of surgical methods are used.
Definition of lunate malacia
The terms lunate malacia and lunate necrosis are just two of the many terms that describe frequent aseptic bone necrosis on the wrist. "Lunatum" refers to one of the eight carpal bones, which is also called the moon leg (Latin: Os lunatum) because of its crescent shape. The disease leads to a gradual death of this bone. The course of the disease can be identified in various stages using imaging methods, for which different classification systems exist.
The term Kienböck disease (Kienböck disease) goes to the doctor and radiologist Dr. med. Robert Kienböck, who first described the disease in 1910.
The most common form of lunate malacia occurs at the age of twenty to forty years. The disease affects women only half as often as men.
Lunate malacia: symptoms
Affected people often complain of local stinging pain on the back of the wrist (wrist pain) or pulling pain down to the forearm (forearm pain). This can also be accompanied by swelling (swelling of the hand) at the appropriate point and a loss of strength in the wrist.
If the joint is examined, pressure pain can typically be triggered in the area of the moon bone. Upon request, those affected cannot usually remember an accident or past injury.
Movement restrictions in the wrist are also possible, but they can also be due to the pain. However, the early phase of the disease can also be symptom-free.
Lunate malacia - causes
So far there is no clear and scientifically proven cause for the death of the moonbone. The greatest consensus is the assumption that the blood supply to the bone is no longer guaranteed and the bone is therefore destroyed by increasing fragmentation.
The causes and beneficial factors of such a circulatory disorder are still being discussed. Certain misalignments of adjacent bones (ulna and spoke) or else (micro) fractures due to external influences can favor the formation and damage the supplying vessels.
Due to the symptoms described (and possibly due to already recognizable risks), expert examination often indicates that lunate malacia is suspected. To confirm the diagnosis, imaging methods are used, which sometimes lead to accidental findings in asymptomatic courses.
First of all, x-rays are usually taken of the wrist, which can be used to identify the specific changes in the bone. One advantage of magnetic resonance imaging (MRI) over the X-ray method is that the disease can be discovered at a very early stage. The interpretation of the images with contrast medium is not always easy or unambiguous, which is why a professional view is extremely important.
Treatment of Kienböck disease
Although treatment is absolutely necessary to prevent complete bone death, there is no generally accepted standard procedure for therapy. Basically, every treatment depends on the stage of the disease and also on the possible causative factors. Age, general health and other personal factors must also be taken into account.
Conservative treatment options are often used in the early stages, such as immobilizing the wrist using a splint (immobilization treatment). However, if the disease is only recognized later - which is relatively often the case - or if the first conservative measures do not lead to success, surgical interventions are necessary.
In general, there are a variety of different methods in which, for example, bones are drilled, shortened or removed. In some cases, wrist stiffening is also performed. Another, newer method is a revascularization operation, in which sufficient blood circulation to the moonbone is to be restored. Partial or complete denervations of the wrist are also used to prevent the transmission of pain.
Surgery is often delayed in children because the growth still has potential for a favorable development of the disease. Older and more frail sufferers are often only concerned with relieving pain.
Holistic medicine for wrist pain
If the diagnosis of symptoms similar to moonbone necrosis can be reliably ruled out and no other serious illnesses are known, manual therapy methods can possibly provide relief from a holistic perspective. For movement restrictions and the described pain, a common diagnosis and treatment method is the fascia distortion model (according to Typaldos). (Tf, cs)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dr. rer. nat. Corinna Schultheis
- Horch, Raymund E., Unglaub, Franck, Dragu, Adrian, Kneser, Ulrich and Bach, Alexander D .: Kienböck's disease. Diagnosis and therapy of lunate necrosis, in: The surgeon, edition 79/2008, The surgeon
- Lichtman, David M., Pientka, William F. and Bain, Gregory Ian: Kienböck Disease: A New Algorithm for the 21st Century, in: Journal of Wrist Surgery, Issue 6 (1) / 2017, Journal of Wrist Surgery
- Kalb, Karlheiz, van Schoonhoven, Jörg, Windolf, Joachim and Pillukat, Thomas: Therapy for Lunate Necrosis, in: The Trauma Surgeon, Issue 5/2018, The Trauma Surgeon
- Engelhardt online lexicon orthopedics and trauma surgery: Lunatum malacia, access: 10.09.2019, lexikon-orthopaedie.com
ICD codes for this disease: M 92.2, M93.1 ICD codes are internationally valid encodings for medical diagnoses. You can find yourself e.g. in doctor's letters or on disability certificates.