Kinböck's disease is diagnosed when a person begins to die off the lunar bone of the wrist. For the first time, the Austrian radiologist Kienbek R. spoke about the disease back in 1910. Today, the most commonly used alternative name is osteonecrosis of the lunate.
The disease itself is associated with the development of aseptic necrosis, which constantly destroys bone tissue. Pain does not appear immediately, progresses during the movement of the hand. In the acute period, pain intensifies and spreads to the entire wrist.
Causes of disease
In most cases, trauma is the provoking factor in the development of pathology. In this case, there may be multiple or single injury to the hand. And the most interesting thing is that a sick person may not even feel that he constantly receives microtraumas, but they disrupt blood circulation in the wrist area, which causes the bone to die.
Representatives of a number of professions are at risk:
- carpenters;
- cranes;
- locksmiths;
- cutters.
In principle, everythingpeople who work with a jackhammer or are associated with any vibration in the workplace are at risk. According to reviews, Kienböck's disease does not make itself felt for a long time and occurs precisely on the working hand.
However, birth defects can also provoke the disease. For example, if a person has a short or long ulna. For this reason, the load on all bones is increased.
According to some reports, this type of pathology occurs against the background of the presence of lupus, sickle cell anemia, cerebral palsy and gout. It was found that 9.4% of patients diagnosed with cerebral palsy acquired osteonecrosis of the lunate bone as a result.
Clinical picture
Pathology goes through four stages. For each stage, the symptoms of Kienböck's disease are different.
The initial stage, as a rule, proceeds without any symptoms. Only occasionally may there be minor pain or discomfort. For this reason, a sick person does not even suspect that he has a problem, and does not go to the hospital. However, problems with the blood supply to the hand, which progress, become a common cause of fractures.
At the second stage, sclerotic changes already begin, the bone hardens. The lack of nutrients manifests itself in the form of swelling in the area of the base of the brush. Pain is frequent, but periodically there is a period of remission. At this stage, changes in the contours of the hand are already clearly visible on the x-ray, so there are no problems with the diagnosis.
Howpatients say they experience pain periodically, but they are very strong and, as a rule, become a reason to see a doctor.
The third stage of Kienböck's disease is characterized by a reduction in the wrist bone. It gradually breaks up into small fragments that can even migrate. At this stage, the patient is practically not relieved of pain, and changes in the bone are clearly visible on an x-ray or MRI.
At the fourth stage, nearby bones are affected, and arthrosis begins in the joints. Patients at this stage suffer from severe pain, a crunch is heard with every movement of the brush.
Regardless of the stage of the disease, there are a number of symptoms that may be present to some extent in a sick person. The most basic symptom is pain and swelling in the wrist area.
Many patients have a weak grip and clicks when moving the hand. There is limited range and difficulty with hand movement.
Some statistics
Most often the disease is diagnosed between the ages of 20 and 60 years. The average age of patients is 32-33 years. But the most important feature that unites all patients is professional activity.
Often this type of pathology occurs in childhood and adolescence from 8 to 14 years. And most often this happens if the child plays certain sports.
It has been observed that adults diagnosed with the disease were involved in physical labor in childhood, before14-16 years old. And this is typical for rural residents.
The disease is diagnosed very rarely in the weak half of humanity.
Diagnosis
The first stage of the disease can last for months or even years. But almost no one goes to the doctor, because the symptoms are hidden.
At the same time, osteochondropathy of the lunate bone of the hand (Kinböck's disease) is difficult to diagnose at the initial stage, many people do not see any changes on the x-ray. However, magnetic resonance imaging will allow you to assess the degree of blood supply, which will allow you to suspect the onset of pathology. However, such thorough research can only be carried out in individuals who are at risk.
Very important differential diagnosis. Often, osteonecrosis of the lunate bone and tuberculosis of the bones have exactly the same symptoms. At the same time, diagnostic measures make it difficult to distinguish between both pathologies. However, the main difference between the diseases is that there is no osteoporosis in osteonecrosis.
It is quite difficult to identify the causes of the disease: it happened as a result of an injury or is the result of professional activity. It is impossible to distinguish Kienböck's disease from the photo and from the clinical picture.
And this is very important when conducting a medical and labor examination, which is appointed to establish disability. The main difference in such cases: if the disease is a consequence of trauma, then it was she who caused the onset of osteonecrosis. When it comes to an occupational disease,the disease precedes the fracture.
Treatment
As soon as the disease is detected and the condition of the bone allows, conservative therapy is carried out. It consists of immobilizing the hand for several weeks. During this time, the blood supply is restored. If the treatment of Kienböck's disease has yielded results, then immobilization is terminated. However, the patient will have to do an x-ray of the hand at least once every two months to track if the disease has begun to progress. If deterioration occurs, then the hand is fixed again.
In some cases, physiotherapeutic procedures are recommended, mud baths, hydrogen sulfide or novocaine blockade may be shown. Although the latest techniques have not been scientifically confirmed, but, according to patients, such procedures are very helpful in relieving pain, even the crunch when moving the brush is reduced.
To relieve pain, paraffin therapy is also recommended, it is with this pathology that heat helps. At home, you can use an ordinary heating pad or a bag of sand. If nothing helped, the disease only progresses, then you will have to go for an operation.
Surgery
At the initial and second stages of Kienböck's disease, revascularization surgery is considered the most effective technique. Its essence is that a he althy fragment with vessels is transplanted onto the damaged bone. Immediately after the operation, the arm is fixed so that the wound heals faster, and the vessels begin to grow faster. Thus, it is possible to restore blood supply and blood flow.
At other stages of Kienböck's disease, surgery is needed or not, which one, the surgeon determines based on the following factors:
- carpal condition;
- patient activity;
- goal and wishes of the patient;
- experience of the doctor himself in carrying out such operations.
Leveling operation
This technique is used if the ulna and radius are of different sizes. A short bone can be lengthened by transplantation or, conversely, shortened. This technique usually allows you to completely stop the progression of the disease.
Corpectomy
Kinböck's disease can go to a stage where the radius completely disintegrates into separate fragments. In such cases, the only way to save the situation is by removing the lunate bone. During a corpectomy, two adjacent bones are also removed. This operation was invented by Kienbek himself, and he performed it quite often. Despite the fact that the range of motion is greatly reduced, it is possible to save other joints from arthrosis.
Merge procedure
This technique involves the partial or complete fusion of the bones of the wrist. This operation reduces pain. Although it will not be possible to fully restore the range of motion of the hand.
If arthrosis has begun, especially in a severe form, then the doctor will most likely perform a complete fusion, despite the fact that the motor function of the hand will be completely lost, the forearm willwork.
Joint Implant
It is often necessary to have a complete bone replacement with a prosthesis in order to restore the function of the hand. In such operations, pyrolytic carbon material is used. Such an operation avoids the development of arthrosis.
Recovery after surgery
Kinböck's disease is a rather complicated disease, especially if it was not possible to correct the situation with the help of conservative therapy.
For 3-4 weeks after surgery, complete immobilization of the hand will be shown, it can be an orthosis or longuet. Such devices allow not only to fix the bones, but also to quickly take root in them, especially when it comes to transplantation, to quickly restore blood supply.
On an ongoing basis, you will have to undergo an X-ray examination for at least 1, 5-2 years. According to patients, rehabilitation after surgery is very long, but to get rid of pain and try to regain the quality of life, it's worth it.
Forecast
With this type of pathology, it is quite difficult to make any predictions. Even if the diagnosis is made at an early stage of the disease. Constant overload and microtrauma only aggravate the situation and increase the disorder of motor function.
And if a person is busy with hard physical labor, he turned to the hospital at a late stage, then you can’t do without the services of a surgeon.
There is another problem. Not every doctor can diagnosecorrect disease even after obtaining the results of x-ray examination. Under any circumstances, it is imperative to consult a doctor and tell what worries you and what your suspicions are.
