Our Summary

Kienbock disease (KD) is a condition that affects the lunate bone in the wrist, causing it to change and degrade. The exact cause of this disease is still unknown. Historically, Lichtman’s classification system, which is based on what can be seen on X-rays, has been used to determine the best treatment. However, a procedure called wrist arthroscopy, which allows doctors to directly examine the lunate bone and surrounding areas, can be a helpful diagnostic tool. It can also be used therapeutically to clean out damaged tissue or to perform surgical procedures. A new method called the Lichtman-Bain algorithm takes into account the condition of the lunate bone, how the wrist is affected, surgical considerations, and patient factors to better guide treatment decisions.

FAQs

  1. What is Kienbock disease and how does it affect the lunate and wrist?
  2. How is wrist arthroscopy used in the diagnosis and treatment of Kienbock disease?
  3. What is the Lichtman-Bain algorithm and how does it guide the management of Kienbock disease?

Doctor’s Tip

A helpful tip a doctor might tell a patient about wrist arthroscopy for Kienbock disease is that it allows for direct assessment of the lunate and surrounding articulations, which can help guide treatment decisions. Additionally, wrist arthroscopy can also be used as a therapeutic tool to perform procedures such as debridement, resection, or arthrodesis. The new Lichtman-Bain algorithm takes into consideration various factors to guide management, so it is important for patients to discuss their specific case with their healthcare provider.

Suitable For

Patients with Kienbock disease, aseptic necrosis of the lunate bone, are typically recommended wrist arthroscopy for diagnostic and therapeutic purposes. Other patients who may benefit from wrist arthroscopy include those with wrist pain, ligament tears, cartilage injuries, ganglion cysts, and arthritis. Wrist arthroscopy can help diagnose the underlying cause of wrist pain and allow for minimally invasive treatment options.

Timeline

Before wrist arthroscopy:

  • Patient experiences wrist pain, swelling, and limited range of motion
  • Patient undergoes physical examination and imaging studies (X-rays, MRI) to diagnose Kienbock disease
  • Treatment options are discussed with the patient, including wrist arthroscopy

After wrist arthroscopy:

  • Patient undergoes wrist arthroscopy procedure to assess the condition of the lunate and surrounding articulations
  • Depending on the findings, debridement, resection, or arthrodesis procedures may be performed
  • Post-operative care includes pain management, physical therapy, and follow-up appointments to monitor recovery and effectiveness of the procedure.

What to Ask Your Doctor

  1. What is wrist arthroscopy and how can it help diagnose and treat my Kienbock disease?
  2. What are the potential risks and complications associated with wrist arthroscopy?
  3. How long is the recovery time after wrist arthroscopy?
  4. Are there any alternative treatment options to wrist arthroscopy for my condition?
  5. How experienced are you in performing wrist arthroscopy procedures for Kienbock disease?
  6. What is the success rate of wrist arthroscopy in treating Kienbock disease?
  7. Will I need any additional treatments or therapies after wrist arthroscopy?
  8. How can I best prepare for wrist arthroscopy and what should I expect during the procedure?
  9. Will I need to follow any specific post-operative care instructions after wrist arthroscopy?
  10. Are there any long-term effects or considerations I should be aware of after undergoing wrist arthroscopy for Kienbock disease?

Reference

Authors: MacLean SBM, Kantar K, Bain GI, Lichtman DM. Journal: Hand Clin. 2017 Nov;33(4):727-734. doi: 10.1016/j.hcl.2017.07.003. PMID: 28991584