When avascular necrosis (AVN) affects the delicate lunate bone within the wrist, it may lead to severe pain and wrist dysfunction unless you pursue treatment promptly. Board-certified plastic and reconstructive surgeon Dr. Jason Ko provides empathetic, patient-centered solutions in Chicago, IL.
What is AVN of the Lunate Bone?
Avascular necrosis (AVN) of the lunate bone, or Kienböck’s disease, occurs when blood flow to this small but crucial wrist bone is cut off, causing the bone to die. The disease can cause severe wrist pain and movement issues if untreated.
Basic Anatomy of the Wrist
- The lunate bone is one of the small bones comprising the carpal tunnel in the wrist. This crescent-shaped bone is near the forearm, between the scaphoid bone (under the thumb) and the triquetrum bone (under the pinky).
- Because your lunate bone plays a critical role in wrist movement, AVN in this bone can cause significant pain, restricted wrist movement, and long-term complications if left untreated.
Symptoms of Lunate AVN
Kienböck’s is a progressive disease, so early and advanced symptoms can be notably different.
Early Symptoms
Symptoms may be fairly mild in the early stages of Kienböck’s disease. Patients often experience wrist pain and discomfort, especially during wrist movement. Tenderness and stiffness in the wrist are also common early on.
Advanced Symptoms
As AVN of the lunate worsens, pain often increases and persists, even when not moving the wrist. Most patients experience a reduced range of wrist motion. Patients may have severe wrist swelling or visible wrist deformity in severe cases.
Progression of Symptoms
Symptoms often increase steadily, varying with the stage of AVN. An early diagnosis is the best way to prevent this progression and manage the condition effectively.
Causes of AVN in the Lunate
Common causes of AVN in the lunate bone are:
- Trauma: Wrist fractures or sprains that compromise blood flow.
- Repetitive Strain: Continuous pressure on the wrist due to occupational or recreational activities.
- Compromised Blood Supply: Poor vascularization makes the lunate vulnerable to AVN.
Risk Factors of Kienböck’s Disease
Risk factors include:
- Age: Commonly affects people aged 20-40.
- Occupation: Jobs requiring repetitive wrist use, such as construction or assembly line work.
- Anatomical Predispositions: Variations in blood vessel structure or other wrist anatomy differences can increase risk. For example, if the ulna bone is shorter than the radius bone, it can put extra pressure on the lunate and could contribute to AVN.
Diagnosis of AVN in the Lunate Bone
Dr. Ko performs a comprehensive exam and reviews your medical history to determine the ideal imaging tests for your needs.
- X-rays: X-rays can help identify bone density loss, often an early indicator of AVN. However, in the earliest stages, X-rays may not show cause for concern, so sometimes other imaging is needed.
- MRI: MRIs provide detailed images of blood flow and can pinpoint early-stage AVN changes. It’s a highly reliable diagnostic tool for Kienböck’s disease.
- CT Scans: CT scans are helpful for advanced and highly detailed evaluations of bone structure and damage.
Stages of Lunate AVN
- Stage I: Mild symptoms; no visible bone collapse.
- Stage II: Early bone density and shape changes, with sclerosis (hardening) of the lunate bone.
- Stage III: Significant bone collapse and deformity may cause abnormal rotation of the nearby scaphoid bone.
- Stage IV: Advanced arthritis and damage to the intercarpal joints.
Importance of Early Diagnosis
Identifying AVN in its initial stages is key to effective treatment and improved outcomes. The earlier you start treatment, the better the odds of a full recovery.
Treatment Options for AVN of the Lunate
Treatment options vary by disease stage and your individual needs. Conservative and surgical approaches aim to alleviate pain, restore function, and prevent progression.
Dr. Ko uses a tailored, individualized approach to ensure that each patient receives optimal care based on their unique condition and lifestyle.
Non-Surgical Management of Lunate AVN
Non-surgical approaches may include:
- Wrist Immobilization and Splinting: Using a cast or splint can reduce strain on the lunate and promote healing. This solution is used mainly in the earlier stages of AVN of the lunate when the bone has yet to collapse.
- Physical Therapy: PT can improve wrist muscle strength and flexibility.
- Medications: Medications may include options such as nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and pain or corticosteroids for short-term symptom relief. In severe cases, some patients need prescription pain relievers.
- Cold Therapy: Ice packs can help relieve swelling and pain.
- Alternative Pain Management: Options like acupuncture and yoga may reduce pain and inflammation.
- Nutritional Changes: Some dietary changes may help support healing, such as glucosamine and chondroitin supplements and an anti-inflammatory diet rich in omega-3s.
Surgical Options for Advanced AVN of the Lunate
Common types of surgeries include:
- Joint Leveling Procedures: Redistributes forces in the wrist to ease stress on the lunate.
- Lunate Replacement: Artificial implants replace the damaged bone.
- Revascularization: Surgical restoration of blood supply to the lunate.
The surgery type and timing depends on factors such as your age, lifestyle, stage of AVN, and overall wrist function. Recovery times vary by procedure but aim to reduce pain and improve wrist stability.
The Importance of Physical Therapy
Physical therapy is important for both non-surgical and surgical treatment plans. Exercises typically include gentle wrist stretches to improve flexibility and strengthening exercises targeting forearm and hand muscles.
For early-stage AVN, physical therapy can slow progression and delay the need for surgical intervention. For later-stage AVN, PT can help you have the smoothest and quickest recovery possible.
Outcomes depend on the stage of diagnosis and adherence to treatment. Early intervention generally leads to better results.
Living with AVN of the Lunate and Preventing Further Damage
Dr. Ko provides practical tips for helping you deal with symptoms, move through recovery, and manage flare-ups, such as:
- Avoid heavy lifting
- Avoid repetitive wrist motions
- Use ergonomic tools
- Wear wrist supports, especially when in pain
- Rest your wrist when needed
Dr. Ko monitors you during regular check-ups to track disease progression and adapt your treatment plan.
Support and Resources for Patients with Kienböck’s Disease
As a renowned expert in orthopedic hand and wrist surgery, Dr. Ko strives to provide comprehensive solutions to patients living with AVN of the lunate. Dr. Ko and our compassionate team may recommend online or local support groups to help you connect with others facing the same challenges.
We want to make sure our patients are well-informed about their disease and its solutions. We point you toward reputable sources for additional information on AVN and wrist health to empower you to take charge of your care. We’re proud to team up with our patients for optimal outcomes!
AVN of the Lunate – Specialist in Chicago, IL
If you’re struggling with wrist or hand pain or stiffness, don’t wait: Call Dr. Ko’s Chicago office to schedule your consultation with the area’s leading expert in wrist AVN.