Lunate Malacia

The Lunate Malacia (Synonyms: Moon leg death, Lunate necrosis or Kienböck's disease) is a disease of a carpal bone in which the moon bone (os lunatum) dies completely or partially (necroses). The disease can reach different degrees of severity with different symptoms.

What is lunate malacia?

In the Lunate Malacia (the doctor also speaks of lunar bone death or Kienböck's disease) progressive disintegration of the small trabeculae in the lunar bone occurs due to reduced blood flow. The human hand is made up of eight carpal bones. The lunar bone (os lunatum) is one of the most important carpal bones and is located in the middle of the wrist. The trabeculae die partially or even completely. Lunate malacia most commonly occurs between around 20 and 40 years of age. Men are twice as likely to get moonbone death as women.

causes

The causes of a Lunate Malacia are not certain, doctors still suspect them to this day. The disease has been known for over 100 years. Even then, the doctor Kienböck suspected that an increasing circulatory disorder was the cause of the lunate malacia. These circulatory disorders can have different reasons.

On the one hand, the lack of blood circulation can be predisposed. Accidents and a fracture of the moonbone can also lead to reduced blood flow and thus to lunate malacia. Another possibility is constant pressure or incorrect loading of the moonbone (can occur, for example, with frequent use of the jackhammer). There are also people who have a shortened ulna in relation to the radius (ulna and radius are the two forearm bones). This “disproportion” can result in a reduced blood flow to the lunar bone.

Symptoms, ailments & signs

Lunate malacia manifests itself as severe hand pain. This is accompanied by a loss of strength in the affected hand. The patient can only strain his hand with great difficulty, a fist and grip movements are no longer possible. The movement restrictions can spread to the wrist. In individual cases, parts of the forearm are also affected.

The intensity of the symptoms depends on the stage of the disease. In the first stage, slight pain and restrictions in freedom of movement develop, which are usually not perceived as a problem by those affected. Only in the second stage do the symptoms intensify and persistent pain occurs.

Usually a visible swelling occurs, which is due to the formation of edema under the skin. In stage III a, the disintegration of the bone is already well advanced. The sick person can no longer fully extend his hand and usually has chronic pain in the hand and wrist area.

In stage III b, a so-called carpal collapse occurs, which is noticeable through symptoms of paralysis. In the fourth stage, the deformity of the hand is complete and pain-free movement of the hand is no longer possible. Symptoms develop over months or even years.

Diagnosis & course

First of all, an X-ray is used to establish the diagnosis. However, a normal X-ray may die Lunate Malacia not yet established in the early stages. Only later stages show up on the X-ray. That is why the disease is often recognized late. Further diagnostic options are magnetic resonance and computer tomography.

The doctor will of course also perform a physical exam. The patient complains of wrist pain and subjectively believes that the wrist is swelling. Pressure on the lunar bone leads to severe pain in this area.

In the differential diagnosis, the doctor can differentiate lunate malacia from tendonitis by the localization of the pain. In lunar bone death, the strongest pain is localized directly above the lunar bone; in tendinitis, the pain spreads equally over different parts of the hand or arm. Supporting the hand also leads to severe pain over the lunar bone.

If the disease is more advanced, the pain spreads over the whole wrist, swelling of the hand occurs and the hand is restricted in movement.

The doctor divides the lunate malacia into four different stages, depending on how severely the lunar bone is damaged. If the disease is very advanced, deformities of the neighboring carpal bones also occur.

Complications

First and foremost, lunate malacia leads to relatively severe pain in the hand. This pain can also spread to the fingers or the back of the hand and cause discomfort there. It is not uncommon for the pain to occur at night and can lead to sleep problems and thus to depression or irritation in the patient.

Furthermore, the muscles of the affected hand are severely weakened and the patient's resilience is significantly reduced. The hand itself can no longer be moved easily, so that there are various restrictions in the patient's everyday life. In many cases the development of children is also affected by the lunate malacia. Swelling or bruises also occur.

In most cases, lunate malacia can be treated well without causing various complications. The life expectancy of the patient is also not reduced with this disease. It is not uncommon for a surgical procedure to be necessary, although this is also not associated with complications. However, those affected also have to rely on various therapies to restore hand movement.

When should you go to the doctor?

Discomfort or pain in the hand should be presented to a doctor. If there is a loss of the usual resilience or a lack of strength in the hand and arm, a doctor should be visited. Restrictions on the range of motion of the wrist should be examined by a doctor. If the daily tasks can no longer be performed or if the person concerned is no longer able to carry out usual sporting activities, a doctor is required. Problems with gripping or holding onto objects are warning signs of the organism.

If even light activities such as opening a door can no longer be carried out, the person concerned must consult a doctor. Circulatory disorders, problems with perception in the hand or discoloration of the skin should be examined and treated. If you experience tingling, numbness, or impaired sensitivity in the hand, see a doctor.

If the symptoms recur or if they become more intense, a visit to a doctor is advisable. If problem areas continue to spread on the hand, a doctor should also be consulted immediately. In the event of swelling, edema or other deformation of the hand, a doctor's visit is necessary. Medical help is required if symptoms of paralysis occur.

Treatment & Therapy

The therapy of Lunate Malacia depends on the stage at hand. First of all, the doctor tries to bring the disease to a standstill as early as possible, i.e. to prevent the disease from progressing. As long as the last stage has not yet been reached, the chances are good.

In the two initial stages, a joint mirror is the method of choice. In this way, the doctor can precisely assess the affected joints and hand bones. A histological examination is also part of the joint imaging. The tissue extraction itself also relieves the bones. He can build himself up again because he now has more space available again.

In the case of a very severe clinical picture, the doctor takes bone material from the patient's pelvis in order to refill the affected carpal bones. If the disease is caused by a shortened ulna, surgery is also necessary in which the doctor either lengthened the ulna or shortened the radius.

Another possibility is that the doctor interrupts certain nerve fibers to prevent pain conduction through these nerves. If the doctor cannot stop the disease despite all the measures taken, partial stiffening of three carpal bones or even stiffening of the entire wrist may be necessary.

In addition to the surgical procedure, the patient needs a forearm cast and, depending on the type of operation, physiotherapeutic exercise therapy.

You can find your medication here

Outlook & forecast

Lunate malacia is a progressive disease. Therefore, the earliest possible treatment is crucial for the further course of development. In the early stages of bone disease, there is a good prospect of a good prognosis. A joint specimen and tissue removal can relieve the bones. The organism then regenerates itself to such an extent that a full recovery can be achieved.

Treatment measures are more complex at an advanced stage of the disease. A surgical procedure is necessary in which bone is removed from the pelvis and inserted into the wrist. The operation involves risks and is much more complex. The likelihood of complications or secondary disorders is increased with this approach. To relieve the pain, the doctor can achieve changes by treating the nerves. This approach is also risky. There is the possibility of damaging the surrounding nerve fibers and thereby triggering secondary symptoms.

If left untreated, the symptoms increase continuously. The physical performance in the hand decreases, so that the fulfillment of everyday duties is difficult. For a good prognosis, in addition to an early diagnosis, physiotherapeutic treatment is advisable. The exercises learned there can also be used by the patient outside of the therapy hours. This improves the well-being and strengthens the organism.

prevention

Prevention is only possible to the extent that excessive and incorrect strain on the wrist is avoided. If there is a congenital circulatory disorder or if the patient has a congenital shortening of the ulna, prevention is not possible.

Aftercare

Regular follow-up checks should be carried out by the attending physician. This includes regular ultrasound examinations of the blood vessels in order to detect further progression of the circulatory disorders in good time. If necessary, treatment could then start promptly and, if necessary, prevent a worse course.

If the impairment due to the circulatory disorder persists, the rehabilitation measures that have been started should also be continued at home. In coping with everyday life, the relatives and those affected must learn to cope with the new situation. More exercise is a means of promoting recovery. Thus, the blood circulation is promoted in a natural way. In general, follow-up care serves to alleviate the existing symptoms, which, depending on their severity, require individual attention.

You can do that yourself

If lunate malacia has occurred, further incorrect loading or, in general, loading of the wrist must still be avoided. This can prevent further damage. As a rule, early diagnosis and treatment have a positive effect on the further course of the disease.

The possibilities for self-help are severely limited with this disease, whereby those affected are usually always dependent on an operation. Without this intervention, the symptoms cannot be alleviated. Patients often need exercise therapy or physical therapy after surgery to restore hand movement. The exercises performed can often be done in your own home, which can accelerate healing. The hand should always be spared and not unnecessarily strained.

In the case of lunate malacia, contact with other sufferers of the disease can often have a positive effect on its course. This can lead to an exchange of information, which can make everyday life easier. Since many sufferers are restricted in their everyday life by the pain, help from relatives or friends also has a positive effect on the course of the disease.