The diagnosis of Kinbek’s disease is made in cases where the person’s wrist bone begins to die. For the first time, the Austrian radiologist Kinbek R. spoke about the disease back in 1910. Today, the alternative name is most often used - osteonecrosis of the lunate bone.
The disease itself is associated with the development of aseptic necrosis, which constantly destroys bone tissue. Pain does not appear immediately, progressing during the movement of the arm. In the acute period, pain increases and spreads to the entire wrist.
Causes of the disease
In most cases, trauma is a provoking factor in the development of pathology. In this case, there may be multiple or single injury to the hand. And the most interesting thing is that a sick person may not even feel that he is constantly getting microtraumas, but they disrupt the circulation of blood in the wrist, which causes bone death.
At risk are representatives of a number of professions:
- joiners;
- crane operators;
- locksmiths;
- foremen.
In principle, all people who work with a jackhammer or are associated with any vibration in the workplace are at risk. According to reviews, Kinbek’s disease has not been felt for a long time and arises precisely on the working hand.
However, birth defects can also provoke the disease. For example, if a person has a short or long ulna. For this reason, the load on all bones is increased.
According to some reports, this type of pathology occurs against the background of the presence of lupus, sickle cell anemia, cerebral palsy and gout. It was found that 9.4% of patients diagnosed with cerebral palsy eventually acquired osteonecrosis of the lunate bone.
Clinical picture
Pathology goes through four stages. For each stage, the symptoms of kinback's disease are different.
The initial stage, as a rule, proceeds without any symptoms. Only sometimes minor pain or discomfort may appear. For this reason, a sick person does not even suspect that he has a problem, and does not go to the hospital. However, problems with blood supply to the hand that progresses become a common cause of fractures.
At the second stage, sclerotic changes are already beginning, the bone hardens. Nutrient deficiency is manifested in the form of swelling in the area of ​​the base of the brush. The pains are frequent, but the period of remission periodically comes. At this stage, changes in the contours of the hand are already clearly visible in the radiological image, therefore, there are no problems with making a diagnosis.
As patients say, pain is tormented periodically, but they are very strong and, as a rule, become an occasion to see a doctor.
The third stage of kinback disease is characterized by a decrease in the wrist bone. It gradually breaks up into small fragments that can even migrate. At this stage, the patient practically does not let go of pain, and changes in the bones are clearly visible on an x-ray or MRI.
In the fourth stage, nearby bones are affected, and arthrosis begins in the joints. Patients at this stage are tormented by severe pain, a crunch is heard with each movement of the hand.
Regardless of the stage of the disease, there are a number of symptoms that may be present in one way or another in a sick person. The most common symptom is pain and swelling in the wrist.
Many patients have a weak grip and clicks when moving the hand. There is a limited range and difficulty with hand movement.
Some statistics
Most often, the disease is diagnosed at the age of 20 to 60 years. The average age of patients is 32-33 years. But the most important feature that unites all patients is professional activity.
Often this type of pathology occurs in childhood and adolescence from 8 to 14 years. And most often this happens if the child is involved in certain sports.
It is noted that adults who are diagnosed with the disease in childhood were involved in physical labor, up to 14-16 years. And this is typical for rural residents.
In a weak half of humanity, the disease is diagnosed very rarely.
Diagnostics
The first stage of the disease can last for months, or even years. But almost no one goes to the doctor, because the symptoms are hidden.
At the same time, osteochondropathy of the lunate bone of the hand (Kinbek’s disease) is difficult to diagnose at the initial stage, in many people no changes are visible on the radiological image. However, magnetic resonance imaging will allow you to assess the degree of blood supply, which will allow you to suspect a beginning pathology. However, such thorough studies can only be carried out in people who are at risk.
A very important differential diagnosis. Often osteonecrosis of the lunar bone and tuberculosis of the bones have exactly the same symptoms. At the same time, diagnostic measures can hardly distinguish between both pathologies. However, the main difference between the diseases is that there is no osteoporosis in osteonecrosis.
It is rather difficult to identify the causes of the disease: it happened due to an injury or is the result of professional activity. From the photo, Kinbek’s disease and the clinical picture cannot be distinguished.
And this is very important when conducting a medical labor examination, which is assigned to establish disability. The main difference in such cases: if the disease is the result of an injury, then it was it that caused osteonecrosis. If we are talking about occupational disease, then the disease precedes a fracture.
Treatment
As soon as the disease is detected and the condition of the bone allows, conservative therapy is carried out. It consists of immobilizing the brush for several weeks. During this time, blood supply is restored. If the treatment of Kinbek's disease has yielded results, then immobilization stops. However, the patient will have to do an X-ray of the brush at least once every two months to track if the disease has progressed. If deterioration occurs, then the brush is again fixed.
In some cases, physiotherapy is recommended; mud baths, hydrogen sulfide or novocaine blockade may be indicated. Although the latest techniques have not been scientifically confirmed, but, as patients say, such procedures are very helpful in relieving pain, even crunching with brush movement is reduced.
Paraffin therapy is also recommended for pain relief, it is with this pathology that heat helps. At home, you can use an ordinary heating pad or a bag of sand. If nothing helps, the disease only progresses, then you will have to go for surgery.
Surgical intervention
At the initial and second stage of Kinbek's disease, the most effective technique is revascularizing surgery. Its essence is that a healthy fragment with vessels is transplanted onto the damaged bone. Immediately after the operation, the arm is fixed so that the wound is overgrown faster, and the vessels begin to sprout faster. Thus, it is possible to restore blood supply and blood flow.
At other stages of Kinbek’s disease, surgery is necessary or not, which one is determined by the surgeon based on the following factors:
- wrist condition;
- patient activity;
- purpose and wishes of the patient;
- the doctor’s own experience in conducting such operations.
Leveling operation
This technique is used if the ulnar and radius are of different sizes. Short bone can be lengthened by transplantation or, conversely, shortened. This technique, as a rule, allows you to completely stop a progressive disease.
Corpectomy
Kinbek's disease can go to such a stage when the radial bone completely disintegrates into separate fragments. In such cases, the situation can only be saved by removing the lunar bone. During a corpectomy, two adjacent bones are also removed. This operation was invented by Kinbek himself, and he often performed it. Despite the fact that the range of motion is greatly reduced, it is possible to save other joints from arthrosis.
Merge procedure
This technique involves partial or complete fusion of the bones of the wrist. This operation allows you to reduce pain. Although it is not possible to completely restore the range of hand movements.
If arthrosis begins, especially in a severe form, then the doctor is likely to conduct a complete merger, despite the fact that the motor function of the arm will be completely lost, the forearm will work.
Joint implant
Quite often, it is necessary to carry out a complete replacement of the bone with a prosthesis in order to restore the functions of the hand. In such operations, pyrolytic carbon material is used. Such an operation avoids the development of arthrosis.
Postoperative Recovery
Kinbek's disease is a rather complicated disease, especially if it was not possible to correct the situation with the help of conservative therapy.
For 3-4 weeks after surgery, a complete immobilization of the hand will be shown, it can be an orthosis or span. Such devices can not only fix the bones, but also quickly take root with them, especially when it comes to transplantation, to quickly restore blood supply.
On an ongoing basis, you will have to undergo an X-ray examination for at least 1.5-2 years. As patients say, rehabilitation after surgery is very long, but to get rid of pain and try to regain the quality of life, it is worth it.
Forecast
With this type of pathology, it is difficult to make any predictions. Even if the diagnosis is made at an early stage of the disease. Constant overloads and microtraumas only contribute to exacerbating the situation and enhancing the impairment of motor function.
But if a person is engaged in heavy physical labor, he turned to the hospital at a late stage, then there is no way to do without the services of a surgeon.
There is one more problem. Not every doctor is able to diagnose the disease correctly even after receiving the results of an X-ray examination. Under any circumstances, it is imperative to consult a doctor and tell what worries and what are the suspicions.