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My nephew was diagnosed with Kienbock's disease and has a lot of trouble with his wrist. I've never heard of it. What causes it and how is it diagnosed and treated?

Doctors don't know what causes Kienbock's disease, but the pain, tenderness, and swelling of the wrist often makes people that they've hurt or sprained their wrist somehow. There are 4 stages to the disease:

• 1- symptoms that look like a sprained wrist
• 2- the small bone in the hand affected by the disease, the lunate, gets hard
• 3- the lunate starts to break
• 4- arthritis may set in the wrist

The diagnosis of Kienbock's disease is a hard one to make precisely because it may seem like the wrist is sprained. If the doctor suspects it early enough, in Stage 1, a magnetic resonance imaging test (MRI) may be helpful. By the time the disease progresses to Stage 2, the damage may be seen on an x-ray because hardened bone looks different from healthy bone. The doctor may choose to do an MRI or a computed tomography (CT) scan. By the time the disease gets to Stage 3, the breaking bones will be obvious on an x-ray.

Treatment for the disease can be conservative, meaning no surgery, or surgery can be done. If the patient and doctor choose to go the conservative route, the wrist may have to be in a brace or cast, and pain medication may help relieve the discomfort. If surgery seems to be the best way to go, an orthopedic surgeon will decide on the best approach.

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