Lunate malacia is a disease of the lunate bone (os lunatum). The lunate bone is one of the carpal bones. Incorrect loading of the wrist, circulatory disorders and accidents can lead to the death of the lunate bone (lunate malacia). As the disease progresses, you should consult a doctor if you experience pain or restricted movement.
Below you will find further information on lunate malacia and specialists for lunate necrosis.
Lunate malacia is also known as moonbone death or Kienböck's disease. It is characterized by the gradual disintegration of the lunate bone, which gives the bone its strength.
In the hand, the lunate bone is one of the most important of the eight carpal bones. It is located approximately in the middle of the carpus. Lunate malacia mainly occurs between the ages of 20 and 40, with men being affected more frequently than women.
Lunate malacia is a reduced blood supply to the lunate bone, one of the carpal bones @ Ihor /AdobeStock
The exact causes of lunate malacia are still unknown. However, doctors assume that circulatory disorders in particular cause parts of the lunate bone to die.
Such circulatory disorders can have a number of causes. On the one hand, some people are prone to poor circulation from birth.
This affects people with ulna and radius of different lengths. In addition, incorrect loading and overloading of the lunate bone can also lead to circulatory disorders.
As a result, parts of the lunate bone die off, severely restricting hand mobility. In this context, lunate malacia is an occupational disease, e.g. in road construction workers who regularly work with jackhammers.
Themain symptom of lunate malacia is severe hand pain. This is usually accompanied by increasing restriction of movement and a loss of strength in the affected hand.
As the condition progresses, the hand can no longer be clenched into a fist. The pain can even radiate into the wrist or forearm.
Lunate malacia progresses in stages, leading to destruction of the lunate bone after months or years. At this stage, swelling occurs as a result of edema under the skin.
The pain makes it impossible to move the hand. The lunate bone collapses as a result of the complete disintegration of the bony beams and signs of paralysis appear.
Doctors need an X-ray to make an exact diagnosis . Nothing can be seen until the bone of the lunate bone is already visibly damaged.
In the early stages, lunate malacia is not visible on an X-ray. This is why doctors only recognize the disease later.
As an alternative to X-rays, other imaging techniques can also be used, such as
The physical examination provides additional information. The doctor presses lightly on the lunate bone, which causes pain. Many patients also report a feeling of pressure in the hand, as if it were swollen.
An important differential diagnosis is tenosynovitis. In this case, however, the main pain shifts to the wrist and forearm in particular.
In lunate malacia, however, the greatest pain sensitivity is in the area of the carpus on the lunate bone.
In the early stages, lunate malacia is not visible on an X-ray @ karelnoppe /AdobeStock
As a general rule, you should see a doctor if you have pain in your hand. Especially if this is accompanied by a loss of strength or restricted movement.
It is particularly critical if you can no longer do even the simplest everyday tasks without pain.
Circulatory disorders can manifest themselves in the form of numbness, tingling or even increasingly pale skin. You should also consult a doctor urgently if you experience these symptoms.
The same applies if the symptoms in the hand occur repeatedly or continue to worsen over weeks. Swelling, restricted movement and deformation of the hand are also warning signs.
In the early stages of the disease, it is usually sufficient to treat the pain . This is mainly done with the help of painkillers, such as non-steroidal anti-inflammatory drugs (NSAIDs) or physical therapy. In addition, doctors usually immobilize the affected hand.
In advanced stages, surgery may be necessary. In individual cases, doctors check whether joint fusion can help.
Doctors can surgically adjust the length of the ulna and radius or fill the damaged areas of the lunate bone with cancellous bone flakes.
Very rarely, they remove the lunate bone (os lunatum) and replace it with a silicone insert.
The earlier doctors recognize and treat lunate malacia, the better the prognosis. In the early stages, it is often sufficient to relieve the pain and undergo arthroscopic treatment. This relieves the pressure on the lunate bone. In most cases, the bone then regenerates.
At an advanced stage, surgery is necessary. Depending on the severity of the symptoms and damage, this can lead to complications. In these cases, physiotherapeutic support measures have proven effective in improving the quality of life of those affected.
Lunate malacia belongs to the field of hand surgery, a branch of orthopaedics and trauma surgery. Look for suitable experts and specialized centers to benefit from their experience in treating lunate malacia.
The earlier you contact the respective centers, the greater the chance of avoiding serious surgery.
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