Dad was just diagnosed with Kienböck Disease of the wrist. Like the stubborn man he is, he is refusing any treatment. What will happen without the surgery the doctor is recommending? Can he heal on his own?
Kienböck 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. 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. In most cases, the disease does get worse without treatment. 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. There are several simple ways to treat this problem. Your father might be willing to try one of these. 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 (loss of blood to the bone) rather than true Kienbock's disease, the condition may also clear up during this time. Transient osteonecrosis sometimes develops briefly after an injury. Surgery may be needed if conservative (nonoperative) care does not produce the desired results (return of blood supply to the bone). And it sounds like the surgeon is advising this step. Although there are many different surgical procedures that can be done, one that is simple and effective is called lunate core decompression. The lunate bone in the wrist is the usual target of Kienböck Disease. Decompression is a surgical technique used to take pressure and load off the bone. The best result is a restoration of blood flow to the area called revascularization. During the lunate decompression surgery, a small hole is drilled into the center of the bone. After surgery, the drill hole gradually fills with tissue. Sometimes, new bone forms within this area. The procedure may help increase the blood flow to the diseased area of bone and allow new blood vessels to form. Core decompression appears to slow down the disease process. It may even stop the progression of disease.