So… today was the visit with the orthopedic surgeon. He palpated my wrist and checked my range of motion. He took some X-rays. The good news is that I don’t have carpal tunnel.

The bad news is that I have something called Kienbock’s disease in both my wrists, but it’s worse in my left wrist. Rather than trying to summarize everything the doctor said, let me break it down this way - first, WebMD:

Kienbock Disease is an acquired bone disorder. Abnormalities of the lunate bone in the wrist develops following an injury or inflammation. Recurrent pain and stiffness occur in conjunction with thickening, swelling and tenderness in soft tissue overlying the lunate bone. The range of motion in the wrist may become limited.

The Kienbock Disease Information Center website has this to say:

Kienbock Disease (KD) is basically, where the blood supply to the Lunate bone in the wrist shuts off and the Lunate bone dies. There are different stages that depends on how much damage has been caused from the lack of blood supply. The bone dies and the body absorbs the dead tissue. This causes the other bones in the wrist to move out of place and rub against each other wrong. This creates a lot of pain.

Kienbock is considered “uncommon” instead of “rare”. All that means is about one in every 150,000 - 200,000 or so get it.

There is no single known cause of Kienbock Disease. Some think over-use causes the problem, but there are many who get it that do not overuse the wrist. There is no one single cause of it. There [do] seem to be many factors that contribute to KD: Overuse, Injury, Genetics, Long Radius, Long Ulna, to just name a few. Most people with KD have varying combinations of factors. This also creates a problem when trying to find a treatment. The treatment depends on the person and the contributing factors.

The American Academy of Orthopedic Surgeons OrthoInfo website has a bit more info…

Kienböck’s Disease

Bone is living tissue that requires a regular supply of blood for nourishment. If the blood supply to a bone stops, the bone can die, a condition known as osteonecrosis. That’s what happens in Kienböck’s disease, which affects the lunate, one of the small bones of the hand near the wrist.

Signs and symptoms

The cause of Kienböck’s disease is unknown. Many people with Kienböck’s disease think they have a sprained wrist at first. They may have experienced some form of trauma to the wrist, such as a fall. This type of trauma can disrupt the blood flow to the lunate. In most people, two vessels supply blood to the lunate, but in some people there is only one source. This puts them at greater risk for developing the disease. As the disease progresses, other signs and symptoms are noted, including:
•A painful and sometimes swollen wrist
•Limited range of motion in the affected wrist (stiffness)
•Decreased grip strength in the hand
•Tenderness directly over the bone (on the top of the hand at about the middle of the wrist)
•Pain or difficulty in turning the hand upward

Progression

Kienböck’s disease follows a specific progressive pattern through four stages.

•Stage 1: Symptoms are similar to those of a wrist sprain. X-rays may be normal or show a line indicating a possible fracture. Magnetic resonance imaging (MRI) may also be helpful in making the diagnosis in this early stage.
•Stage 2: The lunate bone begins to harden. On an X-ray, it may appear brighter or whiter than the surrounding bones. These changes indicate that the bone is dying. Either an MRI or a computed tomography (CT) scan may be used to assess the condition of the bone. Recurrent pain, swelling and wrist tenderness are common.
•Stage 3: The dead bone begins to collapse and break into pieces. The surrounding bones may begin to shift position. Patients experience increasing pain, weakness in gripping, and limited motion.
•Stage 4: The surfaces of adjoining bones are affected, resulting in arthritis of the wrist.

Diagnosis and treatment

In its early stages, Kienböck’s disease may be difficult to diagnose because the symptoms are so similar to those of a sprained wrist. Even X-rays of the wrist may appear normal. At this point, the goal of treatment is to relieve the pressure on the lunate and help restore blood flow within the bone. Your physician may splint or cast your wrist for two to three weeks. Anti-inflammatory medications such as aspirin or ibuprofen will help relieve any pain and reduce swelling. If the pain continues, your physician may refer you to an orthopaedic or hand surgeon for further evaluation.

Surgical options

Although there is no cure, there are several surgical options for treating the more advanced stages of Kienböck’s disease. The right procedure for you will depend on several factors, including disease progression, your personal activity levels and goals and your surgeon’s experience with various procedures. Do not hesitate to discuss these options with your orthopaedic or hand surgeon and to ask why he or she is recommending a particular procedure.

In some cases, returning the blood supply to the bone (revascularization) may be possible. This procedure uses a bone graft from the inner bone of the lower arm. It may be combined with an external fixator, a metal device that helps relieve pressure on the lunate and preserve the spacing between bones.

If the bones of the lower arm are uneven in length, a joint leveling procedure may be recommended. Bones can be made longer with bone grafts, or shortened by removing a section of the bone. This reduces the compressive forces on the lunate and seems to halt progression of the disease. If the lunate is severely collapsed or fragmented, it can be removed. The two bones on either side of it are also removed. This procedure is called a proximal row carpectomy and will relieve pain while maintaining partial wrist motion.

Another way to ease pressure on the bone is to fuse several of the small bones of the hand together. However, this will not improve range of motion. If the disease has progressed to severe arthritis of the wrist, fusing the bones will reduce pain and help maintain function, although motion is limited.

In your arm, you have two bones - for simplicity’s sake, I will refer to them thus - big bone and little bone. My little bone is MUCH shorter than the big bone… about 5mm shorter. Partially because of this shortness, the little bone is sort of pushing into the big bone which is then pushing into the little bones in the wrist, of which the lunate is the one that is being most compressed. Compression of that bone is the whole cause for Kienbock’s. Here’s a picture that sort of shows what my X-ray looked like:

Just that my little bone is a good deal lower than the little bone in that photo. It’s pretty pronounced - the doctor actually went, “Wow!” when he saw the X-ray.

Anyway, I made a call to another orthopedic surgeon for a second opinion and am waiting for his office to call me back about making an appointment. The recommendation from this first doctor is to get the surgery within the next 2-3 months because the longer I wait, the greater the chances of the bone (the lunate is the one near the arrow head) further deteriorating and the greater the chances of me developing some nasty-ass osteoarthritis and losing even more wrist function. As it stands, I won’t ever recover my full range of motion in this left wrist - but at least the pain will be gone and I’ll be able to do yoga and Pilates and stuff again.

Oy. Anyway, I’m glad I know. I can see doctor #2, schedule the surgery and then spend 4 weeks in a cast (since they basically cut a wedge-shaped slice out of my big bone to make it the same length as the short bone and take pressure off the lunate) because they’re creating a bone fracture. Four weeks in hard cast, two weeks in soft cast/splint, and then done. The sooner, the better - I guess.

We’ll see. Right now, I’ve got a hankering for some apple juice.