Lydia's Kienbock Page

My Kienbock's case was initially treated conservatively with casting. Surprisingly, during the month in a cast I progressed from stage I to stage IIIA and my lunate began to degenerate. I opted to have surgery since my lunate was degenerating so rapidly. The operation on October 27,1997 involved a radial shortening, a revascularization procedure and bone graft and the application of an external fixator for added support during the healing process. As of April 2000 I only have occassional pain in my wrist. It is never painful enough to warrant taking any over the counter pain relievers. Of course I am careful to not overuse my hand and avoid overly stressful activities. My hand will never be "normal" again but my condition has been stabilized enough that I can live with my limitations.

If you have questions concerning my case you can reach me at:lkedzierski@yahoo.com

Listen to the pronunciation of the word Kienböck

Click here to visit the Kienbock Support Group Page

Click here to see my operative report
Click here to see post-op photos

Case History

I first exhibited signs of mild wrist and hand pain in my dominant left hand on July 3,1997. On the evening of July 6,1997 the pain became excruciating, as if my hand had had a cinder block dropped on it. I was forced to go to an after-hours clinic due to the pain. X-rays failed to show any signs of a fracture. When the physician's assistant probed my wrist in the area of the lunate I screamed out in pain, as if a knife had been plunged into my wrist. She said I must have a "low threshold of pain" as what she did should not have hurt. Great bedside manner! I was given a shot of pain killer and put in a splint. They told me to come back the next day to see the hand specialist. This incident was the worst pain I had during my entire time up to surgery.

The next day the plastic surgeon who was the clinic's hand specialist examined my wrist. I presented with pain throughout the entire wrist, with the worst pain in the area of the lunate on the palmar side of the wrist, and loss of range of motion. The doctor diagnosed tendonitis and told me to continue to wear the splint while limiting use of my left hand. My case was judged to be a workman's comp case since he thought the tendonitis might be due to typing on my computer at work. I returned two weeks later because the pain had not improved and a customized splint was made since the off the shelf splint did not fit well. I was given Daypro for inflammation and was prescribed a course of physical therapy. The Daypro and the physical therapy seemed to alleviate some of the symptoms. However, I still had poor ROM, pain over the lunate, and loss of grip strength (less than 50% of my non-dominant hand). Despite this, the plastic surgeon examined my wrist again and told me I would continue to improve with time and to come back in two to three months.

After a month of suffering with my wrist pain, I was not satisfied with the plastic surgeon's answer of "wait and see." I could tell something more was wrong. I insisted that workman's comp pay for a second opinion from a orthopedic surgeon with a certificate in hands. The only appointment I could get was a month away - September 5,1997, two months after the onset of my symptoms. The doctor listened to my case history, examined my wrist and took another set of x-rays. Within half an hour of meeting me, he had determined that I might have Kienbock's Disease and needed an MRI to confirm his suspicions.

I had my MRI on September 17,1997. I was given the MRI films to take with me to my doctor's appointment. Upon examining my MRI I noticed that my lunate was grayish black compared to the surrounding carpal bones. Although my doctor had not seen the MRI's yet, I was certain of his diagnosis of Kienbock's. I knew my lunate shouldn't have been black!

On September 19,1997 the orthopedic surgeon confirmed that I had Stage I Kienbock's disease. He felt a conservative approach was appropriate and put me in a fiberglass short arm cast for four weeks. At this time he determined that my case could no longer be considered a workman's comp case since typing was not a contributory cause of the Kienbock's.

Due my case no longer being a workman's comp case I had to change doctors for insurance purposes. I was fortunate to locate another excellent orthopedic surgeon who also had a certificate in hands. My cast was removed on October 17,1997. The doctor planned on taking x-rays and then putting me back in a cast for another month or two since he also recommended conservative treatment. However, upon viewing my x-rays the doctor was surprised to find that I had progressed from stage I to stage IIIA during the month in a cast. My lunate now had a visible fracture on the x-ray and had begun to degenerate. The bottom of the lunate was flattened compared to the prior x-rays. Given my rapid progression, the doctor recommended almost immediate surgery. I was scheduled for surgery on October 27,1997. Since I was ulnar negative, the doctor said he would do a radial shortening combined with a revascularization procedure involving a bone graft from the distal radius to the lunate. Based on my research, I asked if he planned to use an external fixator, as recommended for use in bone graft cases in a paper I found on MedLine. My doctor said he did not plan on using a fixator.

Despite the fine credentials of my doctor, I felt another opinion was warranted. I met with another orthopedic surgeon on the morning of October 23,1997. He agreed with my doctor's diagnosis except he would only perform a radial shortening since he felt the revascularization procedure was unproven. I felt the revascularization procedure made sense, since this would restore blood flow. I decided to proceed with the surgery.

I had my final pre-op visit the afternoon of October 23,1997. During the week since my last visit my doctor had done additional research concerning the use of an external fixator. He agreed that an external fixator would be a good idea in my case (chalk one up to the patient!). The doctor took time to explain the procedure in detail. My surgery was scheduled for 3:00 PM on October 27,1997. He estimated the surgery would take 4 1/2 hours. After surgery I would need to stay in the hospital overnight.

I don't remember much about the afternoon of my surgery. After I changed into the gown an I.V. was started and I was given some medication to make me relax. I don't remember being given the medication that made me go to sleep! I later learned that my surgery had taken 6 1/2 hours instead of the 4 1/2 hours as planned. The doctor took extra time to ensure proper blood flow. My family was relieved when the surgeon finally appeared to tell them how I was doing.

Post-op I would have been in a lot of pain if they hadn't kept me well medicated throughout the night. My arm was wrapped in many layers of dressings and covered by an ace bandage. My fingers were wrapped in co-ban (stretchy bandages) to help prevent swelling. And to top it off, I had four metal posts sticking through the bandages (the fixator). Although I could wiggle my fingers a bit, I did not have much feeling of control over their motion. My doctor came in to see me in the morning and was quite pleased with the results of the operation. By midmorning I was able to transition over to oral pain killers, which was the deciding factor as to when I could be released. I left the hospital around 2PM.

The first week post-op was the worst. I had difficulty sleeping due to the pain. I had to take Endocet every 3 hours at first (you're supposed to take it every 4 hours) but quickly weaned off the medication. Since I had to keep my arm elevated at all times I found it easiest to sleep in a recliner with my arm propped up on several pillows. My arm and fingers were quite swollen and uncomfortable. I was also sick for several days due to the "hangover" effect of the anathesia. Eventually I threw up and felt much better.

My mother came from out of state to be with me during the week following my surgery so my husband could go to work. I am extremely lucky she was there to care for me. The first week is very rough both physically and emotionally. You really need someone there to assist you.

My first post-op visit was a week after surgery. My bandages were removed and I got to see my arm for the first time. It was rather gruesome. I had a six inch long incision on the dorsal side of my arm (the top side). The external fixator was a series of metal bars, nuts and bolts attached to four metal screws that went through my skin and through my bones. I had trouble looking at it but I had to learn how to clean and dress the post sites so I was forced to look. The nurse showed me how to clean the sites with hydrogen peroxide and dress them with Adaptic bandages. I would need to clean the sites twice daily. The doctor was quite pleased with my x-ray (he even patted himself on the back). The lunate looked radically different. It was nice and plump, like a normal lunate. I was pleased too. I was instructed to start working on my finger motion. I could barely wiggle my fingers. The doctor told me he wanted me to be able to make a fist before I got the fixator off.

I took Endocet for approximately two weeks after surgery. Later I found out that I had needed a lot less pain medication than the doctor had expected (so much for "a low threshold of pain").

My doctor said I was able to return to work 2 weeks after surgery. Fortunately my boss allowed me to work from home that first week back. I was still very tired and uncomfortable. The 30 mile drive from my home to work would have been difficult although I was able to drive one handed by this point. Over the following month I worked some days from home and would go in to the office other days.

I had the fixator in place for 13 1/2 weeks after surgery. During that time I became quite adept at cleaning and dressing my arm. I had a few physical therapy sessions and was able to gain enough finger motion that I could make a fist. The doctor and nurse were a bit surprised by that. It seems the doctor was pushing me a bit when he told me I should be able to make a fist - and I believed him so I did it! Most patients do not regain that much motion. Living with a fixator is quite a challenge. It can be physically painful and it is emotionally hard to deal with at times. However, the fixator provides an amazing amount of stability that you do not get from a cast. This aids the healing process. Despite the hardships, I would opt for the fixator if I had to do this over again.

The fixator was removed in late January 1998. The level of discomfort during removal of the screws was comparable to having a tooth filled (maybe not quite as bad). The injection of the local in each of the 4 sites hurt more than the actual removal. The screws were backed out using a stainless steel hand drill. I kept my eyes closed the whole time and did not watch. There was only a minor amount of blood. The holes in my arm were covered with ordinary bandaids (these holes closed up within 24 hours of removal). My wrist was very tender and I had little to no range of motion. The doctor put me in a splint and instructed me to remove it 2 to 3 times per day and gently work on moving my wrist. After the experience of having the fixator removed I was very light headed and faint but I felt better after drinking some soda.

In mid-February 1998, two weeks after removal of the fixator (approx. 3 1/2 months post-op) my doctor told me I could start mildly exercising my wrist and wean off the splint. My range of motion was still limited but had improved. I was told to continue bending my wrist (flexion and extension) and I should now use my other hand to assist. Pain would be my guide as to how much to do. Also, I could start working up to weight bearing activities to a maximum of 10-15 lbs. At this point I could manage a gallon of milk with minimal pain.

In late May 1998 I began two months of physical therapy (16 visits). By my last therapy visit in late July 1998 I had the following measurements:
Grip strength: 30 pounds (vs. 65 in non-dominant right hand)
Flexion: 57 degrees (vs. 95 degrees in right hand)
Extension: 60 degrees (vs. 62 degrees in right hand)

In February 1999 - 14 months after surgery - I had the following measurements:
Grip strength: 44 pounds (vs. 65 in non-dominant right hand)
Flexion: 70 degrees (vs. 95 degrees in right hand)
Extension: 62 degrees (vs. 62 degrees in right hand)

As of April 2000 I only have occassional pain in my wrist. It is never painful enough to warrant taking any over the counter pain relievers. Of course I am careful to not overuse my hand and avoid overly stressful activities. My hand will never be "normal" again but my condition has been stabilized enough that I can live with my limitations.

This page was last-updated April 11, 2000

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