Carpal Tunnel or Kienböck Disease?

Wrist pain and discomfort can seem like the natural consequence of a busy lifestyle that requires near constant use of your hands. However, you shouldn’t experience regular pain or discomfort in your wrist, hands, or arm. Even a slight tingling can indicate a serious problem. Understanding some of the conditions that can affect your wrists is important so you’ll know how to identify potential problems early. The sooner you seek treatment for carpal tunnel syndrome or Kienböck disease, the better your outcome will typically be. Prompt treatment can help you avoid permanent damage.

What Is Carpal Tunnel Syndrome?

The carpal tunnel is a passageway on the palm side of the hand that’s surrounded on three sides by small carpal bones. The transverse carpal ligament forms the roof of the carpal tunnel. The wrist’s primary nerve, known as the median nerve, travels through this narrow opening and up the arm’s length. The median nerve provides feeling to your thumb and all fingers except the pinky. This nerve also controls the muscles at the base of the thumb.

Carpal tunnel syndrome is a condition that occurs when the median nerve is compressed in the wrist. This can happen when the flexor tendons, which also extend through the carpal tunnel, become swollen or when the tunnel itself becomes narrowed.

Some people naturally have a narrower carpal tunnel, increasing their chances of developing this syndrome. Pregnancy and certain health conditions like rheumatoid arthritis, diabetes, and thyroid disease can also increase the chances of developing carpal tunnel syndrome. Any activity involving extreme wrist flexion for long periods of time or repetitive hand and wrist motions may cause swelling that can result in carpal tunnel syndrome.

What Is Kienböck Disease?

The wrist features eight small carpal bones that provide support and movement to this joint. The lunate is one of these bones. Kienböck disease, also known as avascular necrosis of the lunate, occurs when the lunate bone loses blood supply and subsequently dies. Most people have two blood vessels that serve the lunate bone. However, some individuals only have one, which increases the likelihood of developing Kienböck disease.

Kienböck is often caused by trauma to the wrist, which disrupts the blood supply. Individuals with certain conditions like cerebral palsy, sickle cell anemia, and lupus have a greater risk of developing this disease. Kienböck disease may lead to the development of premature arthritis.

Symptoms of Carpal Tunnel vs. Kienböck Disease

The signs and symptoms of carpal tunnel syndrome and Kienböck disease are similar in that they both affect the wrist. Weakness of the hand and difficulty grasping objects or performing fine movements can occur with both conditions. Wrist pain is common with both carpal tunnel syndrome and Kienböck disease. However, you can distinguish these conditions from one another by the nature of the discomfort that you experience. Kienböck disease causes:

• Wrist pain over the lunate bone.
• Swelling.
• Decreased range of motion in the wrist.
• Stiffness of the wrist.

Carpal tunnel syndrome is associated with:

• Shock-like sensations that extend into the fingers.
• Tingling that moves up the arm.
• Itching, tingling, or burning in the palm, thumb, index finger, and/or middle finger.
• Tingling and pain that extends up the forearm to the shoulder.

Both conditions are progressive. They may go undiagnosed for months or even years, as the early symptoms can be mild. Over time, however, symptoms will worsen if the patient doesn’t pursue treatment.

Diagnosing Wrist Pain

Patients must consult with a licensed healthcare provider to diagnose wrist pain. A physical examination is the first step in diagnosing carpal tunnel syndrome and Kienböck disease. The doctor will review your symptoms and look for pain, tenderness, and sensitivity in your wrist and hand. Pressing down on the median nerve, flexing the wrist, and testing sensitivity in the thumbs and fingers can reveal telltale signs of carpal tunnel syndrome. Kienböck disease can be identified by pain over the lunate bone.

Your healthcare provider may order tests such as X-rays or Magnetic Resonance Imaging for a more conclusive diagnosis. When diagnosing carpal tunnel syndrome, doctors may also perform nerve conduction studies or use an electromyogram to measure electrical activity in the muscle.

Treatment for Carpal Tunnel Syndrome

When carpal tunnel syndrome is diagnosed early, it often responds to nonsurgical treatments. Your doctor may advise the use of a brace, splint, or nonsteroidal anti-inflammatory drugs. Changing your wrist position often and performing certain wrist exercises can also promote better movement of the nerve within the carpal tunnel.

When patients have more severe pain, they may need steroid injections to minimize inflammation and treat pain. These injections may provide long-term relief if carpal tunnel syndrome is diagnosed early. Patients with moderate to severe carpal tunnel syndrome may need repeated injections.

Individuals with severe carpal tunnel disease may need surgical treatment known as carpal tunnel release. This is typically an outpatient procedure done under local or general anesthesia. The surgeon cuts the transverse carpal ligament to increase the size of the carpal tunnel and relieve pressure on the median nerve. Over time, the ligament grows back in a lengthened fashion.

Treatment for Kienböck Disease

When Kienböck disease is caught early, it can be treated with nonsurgical options like anti-inflammatory medications and immobilization. This may relieve pain and restore function if the bone has not yet died from lack of blood flow. Your doctor may also opt for revascularization surgery to restore blood flow to the lunate bone. In later stages, Kienböck disease usually requires more extensive surgery. Wrist surgery can improve vascularity by changing the nature of the forces across the lunate bone. In some cases, the lunate and other wrist bones are removed entirely.

If you’re experiencing any type of wrist pain or discomfort, you should consult with a physician as soon as possible. Our team at The Hand and Wrist Institute is experienced in diagnosing and treating a wide range of wrist injuries and conditions. Contact us to make your appointment now.

Image by Towfiqu barbhuiya is licensed with Unsplash License

Dr. John Knight

Dr. Knight is a renowned hand, wrist and upper extremity surgeon with over 25 years of experience. Dr. Knight is a Board Certified Orthopedic Surgeon and Fellowship trained. Dr Knight has appeared on CNN, The Doctors TV, Good Morning America, The Wall Street Journal, The Washington Post, Forbes, The Huffington Post, Entrepreneur, Oxygen network and more.