‘Osteonecrosis of the lunate’- Kienbock’s Disease
As a living Tissue the bone essentially requires:
continuous blood supply to enable functionality. Interruption in the blood supply can make the bone die being referred to as Osteonecrosis. Blood supply can be hindered because of a severe traumatic injury, fracture or dislocation or even without any concrete cause. But if not treated, osteonecrosis can cause the joint to deteriorate and result in severe arthritis.
The wrist is made of a framework :
of eight carpal bones. These carpal bones provide mobility and flexibility to the wrist of a human hand. One among the eight carpal bones is ‘The Lunate’. When blood supply to the lunate gets interrupted it causes clinical death of the bone or avascular necrosis leading to the disease which is known as Kienbock’s disease, a rare and debilitating medical condition resulting in chronic impairment.
Cause of Kienbock’s being unfathomable:
may seem to be just a sprain initially. When pain, numbness, swelling, limited motion ability with decrease in grip strength is visible, then it is relatively diagnosed by various imaging tests and concluded that the patient might be suffering from Kienbock’s disease. The hand specialist Dr. Gupta formulates a treatment plan accordingly to restore the lunate by both surgical or non surgical techniques.
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Rationale:
When the supply of blood to a small wrist bone ‘lunate’ gets interrupted, the bone clinically starts to die causing pain and limitations in wrist movements with a risk of arthritis over a period of years, being referred to as Kienbock's disease. The wrist becomes swollen and starts to lose its grip strength. The reason for lack of blood supply to lunate is still a mystery but certain factors that induce it vary from trauma to the wrist to only supply blood vessel in a person to difference in radial and ulnar bone lengths.
The patient should consult our medical team >>click here for appointment
Approach Considerations:
The progress of Kienbock's disease is very slow and the patient takes several months to understand that medical attention is required. The disease passes through four stages of progression or debilitation, depending on which, the treatment technique is determined by the wrist doctor. The wrist doctor undertakes treatment by nonsurgical techniques during the first two stages when the symptoms have just appeared and the lunate is functional.
Pretreatment evaluation:
The Techniques:
The nonsurgical techniques comprise of -
Non Steroidal Anti Inflammatory Drugs (NSAIDs):
Oral medications commonly known as pain relievers are the initial prescription by the wrist doctor to reduce inflammation and alleviate pain resulting from the kienbock's disease. Available as capsules, tablets, creams, gels and even injections, the effect of each NSAID is equivalent. They provide relief by blocking enzymes in the body that aggravate pain and inflammation.
Steroid Oral Medications or Injections:
Corticosteroids are drugs that are produced naturally from the hormones of the body to reduce the immune system activities. They are converted as drugs and given to the patient either orally or as injections directly in the wrist to alleviate the symptoms. They are given systemically to the whole body or locally into the lunate bone.
Physical Therapy: An essential modality of treatment that is recommended by the wrist doctor to help patient to resume activities without pain or adapt himself to perform activities with the prevalent pain is therapy regime. Physiotherapy exercises combined with other modalities of treatment help in alleviating the pain and swelling and through gentle exercises make the lunate partially functional.
Splinting or casting: To reduce the pressure on the lunate, the wrist doctor may place the wrist in a cast or splint for 2 to 3 weeks to immobilize it. The wrist is covered with layers of soft cotton as the first layer and then given a protective hard covering to ensure permanent safety.
The patient should consult our medical team >>click here for appointment
Post Treatment Follow up:
After the patient is prescribed a combination of nonsurgical treatment, close check on the progress is monitored by the wrist doctor. The patient is asked to be in regular touch with the doctor so that modality of treatment can be changed conveniently depending on the progress of the symptoms.
Potential side-effects or complications:
As with any medication NSAIDs or steroid injections also come laden with potential complications that may occur when given they are given as a high dose or without evaluating past medical history. The potential side effects that might occur after consumption of NSAIDs or steroid injections are-
- Rashes
- Fluctuation in Blood Pressure
- Swelling
- Stomach related problems
- Headaches
- Drowsiness
- Allergic reaction
Benefits:
Nonsurgical techniques act as stabilizers to prevent further deterioration of the wrist until orthopedic or surgical intervention. NSAIDs / injections start to have effect within hours in providing relief and control the enervating symptoms in mild conditions. Splint or casts are the most effective way to control pressure on the lunate and physical therapy helps reduce the stiffness, pain and limitations in mobility.
The patient should consult our medical team >>click here for appointment
More about wrist doctor:
He is an ingenious professional who passionately believes in deliverance of techniques to relief his patients of each and any debilitation in the hand. Dr. Vikas Gupta with his compassionate approach and accurate diagnosis is easily one of the most experienced and skillful wrist doctors in the country. His presence at various national and international seminars, his introduction of various international techniques to Indian field of deliverance has received acclamation and he is an influential role model for his peers and interns.
His experience in the field is more than 25 years with more than 6000 surgeries and innumerable cases that have been provided relief by his nonsurgical prescription and combination of techniques. An MBBS and MS in Orthopedics from All India Institute of Medical Sciences, New Delhi and Fellowship from Germany and USA, he has delivered treatment to patients all around the country from various hospitals that include AIIMS as associate professor, Consultant Hand & Upper Extremity Surgery (orthopedics) At Fortis Hospitals, Director, Hand & Upper Extremity Surgery (orthopedics) At Medanta – The Medicity, Gurgaon and at present head of Hand and Shoulder division at Max Healthcare, the super specialty hospital in Delhi- NCR region.