Kienböck's disease.

Kienböck's disease is an isolated disorder of the lunate resulting from vascular compromise to the bone. The symptoms include wrist pain, limited range of motion, and decreased grip strength. The diagnosis is made from characteristic changes seen in the lunate on radiograms of the wrist. The severity of the disease can be categorized by staging the degree of involvement. This is helpful in guiding the practitioner through the maze of treatment options. Initial treatment of Kienböck's disease is conservative and includes immobilization, analgesics, and/or anti-inflammatory medication. If symptoms are not relieved, then based on the degree of involvement, several surgical options exist that will provide a successful result. These include autogenous tendon replacement arthroplasty, revascularization, radial shortening, ulnar lengthening, limited intercarpal arthrodesis, and silicone replacement arthroplasty. Salvage procedures for Kienböck's disease include wrist denervation, wrist arthrodesis, and proximal-row carpectomy. Currently, we prefer immobilization for treatment of stage I Kienböck's disease. For stage II, a revascularization procedure may be attempted or ulnar lengthening/radial shortening done, particularly if there is significant negative ulnar variance. In stage III, replacement arthroplasty and/or limited intercarpal arthrodesis is our treatment of choice, and for stage IV, one of the salvage procedures is indicated.