Kienbock’s Disease Physiotherapy & Treatment Guide

Best Kienbock’s Disease Treatment in Delhi

What is Kienbock’s Disease ?

Kienbock’s disease is a rare and progressive condition characterized by the loss of blood supply to the lunate bone, one of the small carpal bones in the wrist. This lack of blood flow leads to the death of bone tissue (avascular necrosis), which can cause the lunate to collapse, fragment, and eventually lead to arthritis in the wrist.

Symptoms of Kienbock’s Disease

Symptoms often start subtly and worsen over time. They commonly include:-
- Wrist pain: Often located on the back of the wrist, in the middle, and may worsen with activity or gripping.
- Swelling in the wrist.
- Stiffness and limited range of motion in the wrist, especially difficulty turning the hand upward (supination).
- Decreased grip strength.
- Tenderness directly over the lunate bone.
- Clicking or clunking sounds in the wrist.

Stages of Kienbock's Disease (Lichtman Classification)

Stage I: Lunate loses blood supply. X-rays may appear normal, but MRI shows changes. Pain, swelling, and risk of fracture.
Stage II: Lunate hardens (sclerosis) due to lack of blood supply, visible on X-rays. Lunate shape is still normal.
Stage IIIA: Lunate starts to collapse or fragment. No carpal collapse yet.
Stage IIIB: Lunate collapses and fragments, leading to carpal collapse (other wrist bones shift).
Stage IV: Complete lunate collapse with degenerative changes and arthritis in the wrist joints.

Treatment for Kienbock's Disease

Treatment depends heavily on the stage of the disease and can range from non-surgical to various surgical interventions.
- Non-surgical: For early stages (Stage I, sometimes Stage II), this may include:
- Immobilization: Casting or splinting to rest the wrist and potentially allow blood flow to resume.
- Pain management: Anti-inflammatory medications.
- Activity modification: Avoiding activities that worsen pain or put stress on the wrist.
Surgical: For more advanced stages or when conservative treatment fails, various surgical procedures aim to:
- Restore blood flow (revascularization): Involves grafting bone with a blood supply to the lunate.
- Reduce pressure on the lunate (joint leveling): Shortening or lengthening bones in the forearm (radius or ulna) to equalize their length and reduce compression on the lunate.
- Remove the lunate or parts of it (proximal row carpectomy): If the lunate is severely damaged, it and adjacent bones may be removed to relieve pain, though this limits wrist movement.
- Fuse bones (arthrodesis): Fusing some or all of the wrist bones together to eliminate pain, though it significantly reduces or eliminates wrist movement.

Physiotherapy for Kienbock's Disease

Physiotherapy is a critical component of both non-surgical and post-surgical management for Kienbock’s disease. The goals and techniques will vary significantly depending on the treatment approach and the stage of the disease.

Physiotherapy in Non-Surgical Management (Early Stages/Conservative Treatment)
- Pain and Swelling Management: Modalities like ice, heat, ultrasound, and gentle massage to reduce inflammation and discomfort.
- Rest and Protection: Guidance on proper splinting or bracing, activity modification, and ergonomic advice to minimize stress on the lunate.
- Maintaining Range of Motion: Gentle, pain-free exercises for the wrist and fingers to prevent stiffness in unaffected joints while the lunate rests. This might involve passive range of motion or very gentle active exercises.
- Education: Teaching the patient about the condition, activity precautions, and strategies to protect the wrist.

Physiotherapy Post-Surgical Intervention

Post-surgical rehabilitation is highly specialized and follows specific protocols dictated by the surgeon and the type of surgery performed. Common goals and techniques include:

Immobilization and Protection (Early Post-Op):
- The wrist will typically be immobilized in a cast or splint for several weeks to months to protect the surgical repair.
- Wound care and edema management: Keeping the surgical site clean and dry, and managing swelling through elevation and gentle compression.
- Gentle exercises for unaffected joints: To maintain mobility in the fingers, thumb, and elbow.

Gradual Mobilization and Range of Motion (After Immobilization):

Once the surgeon clears it, the therapist will begin a progressive range of motion program.
- Passive range of motion: The therapist or patient gently moves the wrist joints through their available range.
- Active assisted range of motion: The patient uses their own muscles with assistance from the therapist or the other hand.
- Active range of motion: The patient moves the wrist independently.
Exercises will focus on wrist flexion, extension, radial and ulnar deviation, and forearm rotation.
- Strengthening:

As healing progresses and range of motion improves, a progressive strengthening program is initiated.

- Isometric exercises: Contracting muscles without movement.
- Light resistance exercises: Using therapy putty, resistance bands, or light weights to strengthen wrist flexors, extensors, and grip muscles.
- Dexterity and fine motor control exercises: To improve hand function for daily tasks.

Pain and Swelling Management:
- Continuation of modalities and manual techniques as needed.
- Scar management: Massage and desensitization techniques to improve scar mobility and reduce discomfort.
Functional Training and Return to Activity:
- Gradually integrating the hand into daily activities.
- Ergonomic assessment and advice: Modifying work or leisure activities to reduce stress on the wrist.
- Activity-specific training: For individuals returning to sports or demanding occupations, specific drills and conditioning are implemented.

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