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Maryland Orthopedic Specialists
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Hand & Wrist

Kienböck's Disease

Kienböck's disease responds best to treatment matched precisely to its stage, and outcomes are best when it is caught early. Dr. Peter FitzGibbons manages this condition for patients throughout Montgomery County at our Bethesda and Germantown offices.

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What is kienböck's disease?

Kienböck's disease is a loss of blood supply to the lunate, a small carpal bone in the wrist, which can lead to bone collapse and arthritis if untreated. It causes wrist pain, swelling, stiffness, and weak grip. Treatment depends on the disease stage and ranges from splinting to bone-shortening surgery, bone grafting, or salvage procedures for advanced cases.

Kienböck's disease is avascular necrosis, meaning loss of blood supply and death of bone tissue, affecting the lunate, one of the eight small carpal bones that make up the wrist. Without adequate blood flow, the lunate gradually weakens, collapses, and can shift the alignment of the surrounding carpal bones, eventually leading to wrist-wide arthritis if the disease is allowed to progress untreated (Kienböck's Disease, AAOS OrthoInfo).

The lunate's blood supply varies from person to person. Some people have a single artery feeding the bone, while others have two redundant vessels. Those with only a single feeding vessel are thought to be more vulnerable to a vascular disruption that could trigger the disease, though the precise cause in an individual patient is often not identifiable (idiopathic) (AAOS OrthoInfo).

A recognized risk factor is negative ulnar variance, meaning the ulna, the smaller forearm bone, is relatively shorter than the radius. In this configuration, more of the load transmitted through the wrist passes through the radius directly into the lunate, concentrating stress on a bone that may already have a limited blood supply (Kienböck Disease: A New Algorithm for the 21st Century, PMC). Repetitive loading and trauma are also believed to play a role. The condition most often affects the dominant hand of adults, though a pediatric form, sometimes called "Teenböck," is also recognized and tends to behave differently, with more potential for spontaneous improvement (PMC).

Symptoms — do you recognize these?

Kienböck's disease typically develops gradually, and symptoms tend to track with how far the disease has progressed.

  • Dull, aching pain on the back of the wrist that builds over time
  • Wrist swelling
  • Stiffness and reduced wrist motion
  • Decreased grip strength
  • Tenderness directly over the center of the wrist
  • Pain that worsens with use of the hand and improves with rest, at least early on

If your wrist pain has been building for weeks or months and is not improving, call our office for evaluation, since earlier diagnosis generally allows more joint-preserving treatment options.

How we diagnose it

Diagnosis starts with wrist X-rays, which assess the lunate for sclerosis (bone density changes), fragmentation, and collapse, and also allow measurement of ulnar variance (AAOS OrthoInfo, orthoinfo.aaos.org). Importantly, X-rays can look normal in the earliest stage of the disease. MRI is the key early study because it can detect abnormal marrow signal in the lunate, reflecting reduced blood flow, well before any changes appear on X-ray. MRI is also central to accurate staging (PMC).

We should be candid that grading Kienböck's disease from X-rays alone has real limitations. Studies examining how consistently different observers stage the same X-rays have found agreement ranging from moderate to substantial depending on the study and on whether the classic four-stage system or a refined version is used, which is one reason MRI-based and other cross-referenced staging systems are increasingly incorporated into modern treatment decisions rather than relying on X-ray staging in isolation (Kienböck Disease algorithm review, PMC; Goldfarb et al., J Hand Surg Am, PubMed).

The staging system most commonly used, the Lichtman classification, is described in detail below and directly guides treatment selection.

Treatment options

Treatment for Kienböck's disease is chosen based on the Lichtman stage, the shape of the lunate, whether it has fragmented, and the patient's ulnar variance. Earlier-stage disease generally allows joint-preserving treatment, while later stages often require procedures that trade some wrist motion for pain relief.

Immobilization and observation

Casting or splinting the wrist along with activity modification and anti-inflammatory medication, combined with periodic imaging to monitor for progression.

When used: Early-stage disease (Lichtman Stage I, sometimes early Stage II), when the lunate has not yet collapsed (AAOS OrthoInfo, orthoinfo.aaos.org; PMC).

Surgical Procedure

Proximal Row Carpectomy

Motion-preserving wrist salvage procedure that removes the scaphoid, lunate, and triquetrum, allowing the capitate to articulate directly with the lunate fossa. Relieves arthritic pain while preserving meaningful wrist motion in SLAC and SNAC wrist.

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Recovery & rehabilitation

Recovery and long-term function after treatment for Kienböck's disease depend heavily on the stage at which the disease was diagnosed and treated. Earlier-stage disease treated with joint-leveling osteotomies or revascularization procedures generally preserves more of the wrist's native motion and anatomy. Later-stage salvage procedures such as proximal row carpectomy or wrist fusion reliably relieve pain but come at the cost of reduced wrist motion (AAOS OrthoInfo, orthoinfo.aaos.org; PMC).

Bone-shortening osteotomies require the bone to heal, generally over six to twelve weeks, followed by progressive strengthening and motion exercises. Vascularized bone grafting requires patience, since restoring blood flow and allowing the graft to support the lunate takes months, with functional recovery typically measured over four to six months. Because outcomes correlate so strongly with the stage at diagnosis, early evaluation is genuinely important. This is a case where waiting to see if symptoms improve on their own can allow the disease to advance to a stage where motion-preserving surgery is no longer an option.

Frequently Asked Questions

Can Kienböck's disease be cured?
There is no way to restore a fully normal lunate once significant collapse has occurred, but the disease can be effectively treated at every stage. Earlier-stage disease treated with joint-leveling surgery or a vascularized bone graft can preserve much of the wrist's normal motion and prevent further collapse. Later-stage disease is treated with procedures that reliably relieve pain, such as proximal row carpectomy or wrist fusion, though these trade some motion for that pain relief. The goal at every stage is to stop progression and restore as much function as the stage allows.
Why does the treatment depend so much on the stage of the disease?
Because the underlying problem changes as the disease progresses. Early on, the lunate's shape is intact but its blood supply is compromised, so treatment focuses on reducing load on the bone or restoring blood flow to it. Once the bone has collapsed and the surrounding carpal bones have shifted position, restoring the lunate is no longer realistic, and treatment shifts toward bypassing or removing the damaged bone. Matching the procedure to the stage is the single biggest factor in getting a good result.
Is X-ray staging alone reliable for planning treatment?
Not entirely, and we think it is important for patients to know that. Studies looking at how consistently different examiners stage the same X-rays have found only moderate agreement between observers. That is why MRI, which can detect early changes in blood flow to the bone before X-ray changes appear, plays such an important role, and why staging in practice draws on more than X-rays alone.
What causes Kienböck's disease?
In many patients, no single clear cause is identifiable, which is why the condition is often called idiopathic. A recognized contributing factor is negative ulnar variance, where the ulna is relatively shorter than the radius, concentrating more wrist load through the lunate. Variation in the lunate's own blood supply, with some people having only a single feeding vessel rather than two, is thought to make certain individuals more susceptible to a vascular disruption that triggers the disease. Repetitive loading and prior trauma may also contribute.
Does Kienböck's disease affect children differently than adults?
Yes. A pediatric form of the disease, sometimes called Teenböck, affects patients under 15 and is generally managed more conservatively than the adult form, because children have real potential for spontaneous improvement as they continue to grow. Treatment recommendations also differ somewhat for patients in their late teens and early twenties compared with older adults, and tend to become more limited and salvage-focused in patients over 70.

Meet the specialists

Peter G. Fitzgibbons, MD

Peter G. Fitzgibbons, MD

Hand Surgery · Orthopedic Surgery

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Related conditions

Ulnar Impaction Syndrome
Medically reviewed by Peter G. Fitzgibbons, MD, MD
Last reviewed August 5, 2026

References

  1. Kienböck's Disease. AAOS OrthoInfo.
  2. Kienböck Disease: A New Algorithm for the 21st Century. PMC.
  3. Goldfarb CA, Hsu J, Gelberman RH, Boyer MI. The Lichtman classification for Kienböck's disease: an assessment of reliability. J Hand Surg Am. 2003;28(1):74-80.
  4. Croog AS, Stern PJ. Proximal row carpectomy for advanced Kienböck's disease: average 10-year follow-up. J Hand Surg Am. 2008;33(7):1122-1130.
  5. Jafarnia K, Collins ED, Kohl HW 3rd, Bennett JB, Ilahi OA. Reliability of the Lichtman classification of Kienböck's disease. J Hand Surg Am. 2000;25(3):529-534.
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