Kienböck's disease: when a wrist bone loses its blood supply, and what helps

What it is, and the stages

The lunate is one of the eight small wrist bones, in the middle of the wrist between the forearm and the hand. In Kienböck's disease its blood supply is interrupted, and the bone loses its strength and can collapse, causing a painful, stiff wrist; over time, arthritis develops in the bones around it. It is named after Robert Kienböck, a radiologist who described it in 1910.

Treatment is planned by stage (the Lichtman stages), and newer systems add a contrast MRI scan (how much blood flow is left) and keyhole surgery (whether the cartilage is intact), which surgeons use to choose an operation.

• Stage I: symptoms like a sprain; X-rays may look normal, and an MRI scan shows the change in blood flow.
• Stage II: the lunate looks denser on X-ray, with pain and swelling, especially taking weight through the wrist.
• Stage III: the lunate collapses or breaks up (IIIA), then the bones around it shift (IIIB).
• Stage IV: arthritis in the wrist.

Sources 1, 2, 3

Who gets itEmerging evidence

It is rare. In Finland, from 1996 to 2022, about 1 person in 100,000 a year was diagnosed (9.6 per million), most often at 50 to 59, and men had 24% more cases than women. Among 51,071 people whose wrists were imaged at one US hospital over 11 years, 0.27% had Kienböck's, men and women about equally; 37% of them had no symptoms from it. In 350 people who had surgery for it, 2.9% had it in both wrists.

Teenagers and adults over about 70 have a better outlook; in older adults it affects women more often, and it goes with thinning bones (osteoporosis) and inflammatory and autoimmune conditions.

Sources 4, 5, 6, 2, 7

Why it happensMixed evidence

The cause is unknown. Reviews describe an 'at-risk' lunate (a single blood vessel to it in some people, the shape of the bone, and the relative lengths of the forearm bones) meeting a trigger. A forearm bone that ends shorter at the wrist is often blamed, but one review reports that it is common in people without the disease, so most people who have it never develop Kienböck's.

In Finland, a previous hand or wrist injury came with about 3 times the odds, though Kienböck's after a single injury is rare and reported mostly in single cases. Alcohol misuse, rheumatic diseases and clotting disorders were also linked. A systematic review of 152 articles found no good evidence that vibrating tools cause it, and it isn't on the UK list of prescribed industrial diseases. US surgeons describe extra pressure on the lunate in push-ups in people with uneven forearm bones.

Sources 2, 8, 5, 9, 10, 11, 1

How it's diagnosed, and what scans do and don't meanEmerging evidence

The symptoms are wrist pain, swelling, stiffness, a weaker grip and tenderness over the middle of the back of the wrist. It usually progresses slowly, and many people think they've sprained the wrist at first. An NHS hand clinic describes the pain as usually dull and constant, worse with use and better, but not gone, with rest.

X-rays come first, but in stage I they can be normal: an MRI scan shows the change, and a CT (computed tomography) scan shows collapse. Even with special scans, the early diagnosis isn't always clear. Kienböck's changes can also turn up by chance: 37% of the cases found at one hospital caused no symptoms, and the symptoms didn't reflect how severe the changes were. The diagnosis and stage come from your symptoms, the examination and the scans together, read by a hand specialist.

Sources 1, 3, 2, 6

How it usually goesEmerging evidence

Left alone, the lunate tends to move through the stages over years. A review describes pain and swelling that come and go, then persistent pain, then settling as arthritis develops, over 5 years or more, and says symptoms generally ease with time even without treatment.

In a long-term series of 49 wrists, 83% of those treated in plaster and 77% of those left untreated were pain-free or painful only with heavy work, although every lunate was deformed and 67% had arthritis. An NHS hand clinic says some lunates partly regain their blood supply and stay stable, while others collapse. In Finland, 44% of people had an operation, and 19% of those had more than one. US surgeons say not to expect a fully normal wrist, but that treatment gives the best chance of long-term pain relief and keeping function.

Sources 2, 12, 3, 4, 1

A hand specialist decides, by stage and ageEmerging evidence

A 2025 review's approach: children under 15 are treated without surgery; at 15 to 20, 3 to 6 months of immobilisation come first; at 65 and over, non-surgical care (splints, anti-inflammatories and hand therapy), with checks for osteoporosis and inflammatory arthritis. Adults with an intact lunate may have an operation to take pressure off it (shortening the radius or the capitate bone) or to bring in a new blood supply; a damaged lunate may need a partial wrist fusion; and once arthritis has set in, removing the first row of wrist bones or fusing part or all of the wrist.

The review adds that non-surgical treatment is always an option, especially for older, less active people with mild symptoms, and that almost all the studies behind these recommendations are small, uncontrolled case series.

Sources 2, 1, 3, 13

No treatment has been shown to change its courseEmerging evidence

A 2010 systematic review found no active treatment better than another, and too little data to say whether any beats a placebo or the natural course. Over 10 years or more, shortening the radius and non-surgical care showed the same rate of worsening on X-ray, though fewer people had more than moderate pain after the operation (5.7% against 23.2%) and the wrist moved more (107 against 89 degrees); all those studies looked back at past patients. A vascularised bone graft was followed by less worsening of the stage (17% against 40%) and less pain over 5 years or more, but without meaningful differences overall.

US surgeons say joint-levelling operations often stop the disease getting worse, but the long-term review didn't show that. Operations that remove or fuse bones relieve pain at the cost of some movement.

Sources 14, 15, 16, 1

Splints and restEmerging evidence

US surgeons suggest anti-inflammatory medicine and a short period in a splint or cast in the earliest stage, with surgery if the pain isn't relieved or comes back. An NHS hand clinic usually recommends a period in a splint, with an anti-inflammatory if needed, and scans the wrist again about 6 months later; it calls this the most common approach.

As your hand team advises: one expert review (very low certainty) suggests a made-to-measure wrist splint holding the wrist slightly bent back, with the knuckles and thumb free, for a 6 to 12 week trial, then weaning to night-only or activity-only use over another 6 to 12 weeks, with reviews at 3 and 6 months. It says the usual three-month trial comes from expert opinion, not trials. In the long-term series, plaster did no better than no treatment, and the review warns that long, rigid immobilisation impairs control of the wrist.

Sources 1, 3, 8, 12

Exercise can't heal the boneEmerging evidence

No trial has tested exercise in Kienböck's disease. As your hand team advises, one expert review (very low certainty) suggests: move the shoulder, elbow and fingers from day one; start wrist movement at about 4 to 6 weeks, first in the 'dart-thrower's' direction (from bent back towards the thumb to bent forward towards the little finger, like hammering or pouring), which moves the lunate less than ordinary bending; start strengthening with still grip work, wrist straight; and add moving loads only when there is no pain at rest, the wrist moves as well as the other side in that direction, grip is at least three-quarters of the other hand's, and pain during activity is 2 out of 10 or less. It suggests short, frequent sessions, such as four 5-minute sessions a day.

While the bone is protected, the review advises cutting back loaded wrist extension and gripping with the wrist bent towards the thumb, at work and in sport, climbing in particular.

Sources 8, 1

Other treatmentsEmerging evidence

For bone drugs (bisphosphonates), magnetic field therapy, shockwave therapy and hyperbaric oxygen, the 2026 review found no Kienböck's trials and too little evidence to recommend them outside research. Anti-inflammatory medicines ease the symptoms but don't appear to change the course.

Source 8

Children and teenagersEmerging evidence

It's rare in children, and the outlook is better. A review advises treating children under 15 without surgery, as symptoms generally settle with time, and a systematic review recommends a non-surgical approach until 15. A 2026 review of 69 studies found few data, mostly case reports and small series: 26 children treated without surgery and 142 with surgery.

Sources 2, 13, 17

The dart-thrower's movement (written steps)

The direction one expert review suggests for the first wrist movements; the steps are our suggestion.

• 1. Only once your hand team allows wrist movement.
• 2. Sit with your forearm resting on a table, thumb up, your hand over the edge.
• 3. Move your hand up and back towards the thumb side, as if cocking a hammer.
• 4. Then down and forward towards the little-finger side, as if hammering a nail or pouring from a jug.
• 5. 10 slow repetitions in a pain-free range, in short sessions through the day (our suggestion).

Source 8

Thumb movement in a splint (written steps)

The review suggests moving the fingers from day one; these thumb steps and counts are our suggestion.

• 1. If the splint leaves your thumb free, touch the tip of your thumb to each fingertip in turn.
• 2. Then slide your thumb across your palm towards the base of your little finger, and back out wide.
• 3. A few times an hour while you're awake, within comfort (our suggestion).

Source 8

After surgery (as your team allows)

Your surgical team's protocol comes first. One review describes current practice after some operations; many of the timings are expert consensus or the authors' own practice, not standards.

• 1. Shortening the radius: a cast for about 6 weeks, wrist movement in the dart-thrower's direction from about week 6, and grip work from about weeks 10 to 14.
• 2. Removing the first row of wrist bones: a splint for 10 to 14 days, active wrist movement from about 2 to 3 weeks, and no heavy loading or power grip until about 16 to 24 weeks. Rehabilitation aims at function within the new range.
• 3. A partial wrist fusion (four-corner fusion): a cast for 4 to 6 weeks, and no loading until about 16 to 24 weeks.
• 4. A vascularised bone graft: heavy loading and heavy work wait until scans confirm the new blood supply, often months.
• 5. A wrist replacement: lifelong limits on heavy lifting, impact sport and vibrating tools.

Source 8

Back to sport and work

Gymnastics, CrossFit, yoga, climbing and boxing put weight or impact through the hands, or hard grip on the wrist, so they come back last, after your specialist clears them, in short sessions (our suggestion). Push-up handles keep the wrist straight but still load the wrist bones, so ask first. For hand-intensive jobs, the review advises cutting back loaded wrist extension and gripping with the wrist bent towards the thumb, with progress guided by symptoms and repeat scans. Leg, core and cardio training can carry on throughout.

Sources 8, 1