About lunatomalacia

What is lunatomalacia?

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.

What are the symptoms for lunatomalacia?

In the early stage of the disease, your wrist is painful. As the disease progresses, symptoms include:

  • tenderness over the bone
  • stiffness
  • swelling
  • decreased hand grip
  • difficulty turning the hand upward
  • clicking sound when your wrist moves

What are the causes for lunatomalacia?

The exact cause of Kienbock’s disease is unknown.

It’s often associated with an injury to your wrist, such as a fall, that affects blood supply to your lunate. It also is associated with repetitive micro-injuries to your wrist, such as from jackhammer use.

What are the treatments for lunatomalacia?

Treatment for Kienbock’s disease depends on the severity of pain and the stage of lunate deterioration.

In an early stage of Kienbock’s disease, your doctor may prescribe anti-inflammatory drugs to relieve pain and swelling. Immobilization of your wrist may take pressure off the lunate and help restore the flow of blood to the bone. Your doctor may advise putting your wrist in a splint or cast for 2 or 3 weeks to keep it immobile.

Physical therapy can also help to improve the range of motion in your wrist. A physical therapist can assess your wrist and provide an exercise routine to help maintain your wrist use.

If you have more pain or the lunate is deteriorated, your doctor may advise surgery. There are several options available, depending on the degree of damage.


This involves grafting a piece of bone and blood vessels from another bone in your hand or arm to the lunate to restore blood flow. A piece of metal on your wrist (external fixator) may be used to keep the graft in place and relieve pressure on the lunate.

Capitate-shortening osteotomy

This procedure removes a piece of another wrist bone, the capitate, and fuses it with other segments of the same bone. It’s used in early stages of Kienbock’s disease, combined with revascularization.

Joint leveling

This procedure is used to help stop the disease from progressing when your two forearm bones are not the same length. It may involve removing a section of the longer bone (usually the radius), or grafting a piece of bone onto the shorter bone (usually the ulna). This relieves pressure on the lunate.

Metaphyseal core decompression

This procedure levels your forearm bones by scraping the two bones involved without removing any bone tissue.

Proximal row carpectomy

This procedure removes the lunate bone if it has collapsed, along with two adjoining bones. This relieves pain, but leaves you with only partial wrist motion.


The lunate is fused to adjoining bones to create a solid bone. This procedure relieves pain and leaves you with partial wrist motion.


This would include a total wrist joint replacement. A resection arthroplasty in which the lunate is replaced with an artificial bone (made of silicon or pyrocarbon) has been done, but this procedure is used less frequently.

What are the risk factors for lunatomalacia?

  • Differences in the length and shape of your forearm bones, the radius, and the ulna. This can put more pressure on your lunate.
  • Only one blood vessel supplying blood to your bone, instead of the usual two. This can affect blood supply to your bone.
  • Other diseases, such as lupus, sickle cell anemia, cerebral palsy, and diseases that affect blood supply, are associated with Kienbock’s disease.

Kienbock’s disease occurs most commonly in men between 20 and 40 years old. You’re also at an increased risk if you regularly do heavy manual labor.

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