Kienböck's disease is a loss of blood supply to the lunate, the small bone at the centre of the wrist. Without blood the bone softens, and over months to years it can fragment and collapse, taking the alignment of the whole wrist with it. Preiser's disease is the same process in the scaphoid, and is rarer. Both usually start as a dull ache in the wrist that is easy to dismiss, and both are staged on X-ray and MRI. Treatment depends on the stage. Early disease can be rested and watched. Later disease has a range of operations, and the aim of each is a wrist that is comfortable and useful.
What is Kienböck's disease?
The lunate sits in the middle of the first row of carpal bones, between the end of the radius and the capitate, and carries much of the load passing from the hand into the forearm. Its blood supply comes in through a few small vessels, in some people only one, which leaves it vulnerable.
In Kienböck's disease that supply fails. The bone becomes dense on X-ray, then softens, then breaks up under the loads of ordinary use. As it loses height the scaphoid tips forward and the rest of the wrist shifts to fill the gap, and once that happens the cartilage of the surrounding joints wears.
It is staged by what the imaging shows:
Stage 1. The X-ray is normal. The MRI shows the lunate has lost its blood supply.
Stage 2. The lunate looks dense and white on X-ray but has kept its shape.
Stage 3. The lunate has started to collapse. In 3A the rest of the wrist is still aligned; in 3B the scaphoid has tipped and the carpus has shifted.
Stage 4. Arthritis has developed in the joints around the lunate.
The stage drives the treatment.
Preiser's disease
Preiser's disease is loss of blood supply to the scaphoid without a fracture. It behaves much like Kienböck's: ache on the thumb side of the wrist, dense bone on X-ray, then fragmentation and collapse. A scaphoid that loses its blood supply after a fracture is a different problem, covered on our scaphoid fracture page.
Symptoms
Most people describe:
- A dull ache in the centre of the wrist that has been there for months, worse after use
- Tenderness over the back of the wrist, directly over the lunate
- Stiffness, with wrist bending and straightening gradually reducing
- Weak grip, and difficulty with push-ups, lifting or leaning on the hand
- Swelling over the back of the wrist in later stages
Symptoms often lag behind the X-ray.
Causes and risk factors
The cause is not fully understood, and in most people no single reason is found. What is known to contribute:
A short ulna. Where the ulna is shorter than the radius at the wrist, called negative ulnar variance, the lunate takes more load against the edge of the radius. This is the strongest association, and it changes which operation we recommend.
Repetitive loading. Kienböck's is most common in men in their twenties and thirties who do heavy manual work.
Injury. A single fall or hyperextension injury sometimes precedes it, though many people recall none.
Preiser's disease in particular is linked to corticosteroid use and to conditions that affect small blood vessels.
How it is diagnosed
By examination and imaging. Tenderness directly over the lunate, with reduced movement and grip compared with the other side, raises the question. Imaging answers it.
X-rays show the density and shape of the lunate, the alignment of the wrist, and the relative lengths of the radius and ulna. In stage 1 they are normal.
MRI makes the diagnosis early. It shows loss of blood supply months before the X-ray changes, and whether any of the lunate is still alive.
CT shows the bone in detail: whether it has fractured, how much has collapsed, and whether the surrounding joint surfaces have worn. It is the scan we use to plan surgery.
Non-surgical treatment
In stage 1 and some stage 2 disease, and in anyone whose symptoms are mild, we start here.
Rest and splinting
A wrist splint takes load off the lunate and gives the bone its chance to recover blood supply. In early disease it is worn for up to three months, with a repeat MRI to see whether the bone has recovered. Our therapists fit the splint, keep the fingers and forearm moving, and manage the return to activity. Therapy is on site and starts the same week.
Activity change
Avoiding push-ups, heavy lifting and impact through the wrist, and changing the way manual work is done.
Medication and injection
Anti-inflammatory medication helps with the ache. A corticosteroid injection into the wrist can settle a painful flare where arthritis has started, though it does not restore blood supply. We arrange injections under ultrasound guidance, and would not repeat one more than twice in the same wrist.
When surgery is needed
Surgery is advised where the lunate has not recovered despite rest, where the bone is collapsing, or where pain is limiting what you do. The choice depends on the stage, the length of your ulna, the condition of the cartilage, and your age and what you need the wrist for. We go through which operations suit you at your consultation.
Radial shortening
Where the ulna is short and the lunate has kept its shape, shortening the radius by a few millimetres evens up the load at the wrist and takes pressure off the lunate. The radius is cut, a small sliver removed and the bone fixed with a plate. It is a day procedure or overnight stay under a general anaesthetic with a local anaesthetic block, and takes about 60 to 90 minutes. The bone heals over six to twelve weeks in a splint.
Vascularised bone graft
Where the lunate has lost its blood supply but not collapsed, a piece of bone with its own blood vessel attached is taken from the end of the radius and set into the lunate. The living graft brings blood supply with it, and the aim is for the lunate to heal and keep its shape. It is done through an incision on the back of the wrist under a general anaesthetic with a local anaesthetic block, as a day procedure or overnight stay, and takes about 90 to 120 minutes. The wrist is protected in a plaster and then a splint for eight to twelve weeks. The same principle applies to the scaphoid in Preiser's disease.
Proximal row carpectomy
Where the lunate has fragmented, the three bones of the first row, the scaphoid, lunate and triquetrum, are removed. The capitate then settles into the socket of the radius and becomes the new wrist joint. It is a reliable operation: the wrist keeps about two thirds of its movement and a good proportion of its strength, there is no implant, and the recovery is shorter than after a fusion. It needs the cartilage on the capitate and radius to be in good condition. It is done through an incision on the back of the wrist, as a day procedure or overnight stay under a general anaesthetic with a local anaesthetic block, and takes about 60 to 90 minutes.
Partial or total wrist fusion
Where arthritis has spread beyond the lunate, a partial fusion of the wrist bones, or in advanced cases a fusion of the whole wrist, gives a comfortable, strong wrist at the cost of movement. These are described on our SLAC and SNAC wrist page.
Recovery, week by week
Indicative, for a proximal row carpectomy. After a bone graft or radial shortening the bone has to heal, so splinting is longer and the heavier stages come later.
Day of surgery. Your hand and arm may feel numb for up to 24 hours because of the local anaesthetic block. You can move your fingers before you leave hospital. The wrist is in a plaster backslab.
Days 1 to 10. Keep the plaster clean and dry. Keep the hand elevated. Move your fingers, elbow and shoulder regularly to prevent stiffness.
Days 10 to 14. Review by the doctor, hand therapist or practice nurse. Sutures are removed. The plaster is replaced with a custom made removable wrist splint fitted by your hand therapist.
Four weeks. Gentle wrist exercises begin out of the splint, guided by your hand therapist. The splint is still worn for protection and at night.
Six weeks. Progress is reviewed with new X-rays. The splint is weaned and light use of the hand begins.
Three months. Grip strengthening progresses. A graded return to heavier tasks starts.
Six to twelve months. Strength and stamina keep improving. The wrist may stay stiff or tender for several months and continues to improve for up to a year.
Driving and work. Driving once splinting stops, at six weeks. Office work at about two weeks in the splint. Heavy manual work from three to six months.
After a bone graft or radial shortening expect splinting for eight to twelve weeks, with X-rays or a CT to confirm the bone has healed before heavy use.
Risks and complications
Wrist surgery for Kienböck's disease is safe, and complications are uncommon. They can include:
Wound healing problems or infection. Usually superficial and treated with antibiotics.
Bleeding or bruising.
Nerve injury. The small sensory nerves on the back of the wrist run close to the incision, and a patch of numbness or tingling on the back of the hand can result.
Stiffness. Some loss of movement is expected after any of these operations, and more after a fusion.
Ongoing tenderness around the scar, or slower than expected recovery.
After a bone graft, the lunate may not recover or may continue to collapse, and a further operation may be needed.
After a radial shortening, the bone may be slow to heal, and the plate may need removal later if it irritates.
After a proximal row carpectomy, the new joint can wear over the years, and a small number of people later need a fusion.
When to be seen sooner
Contact us, or see your GP, if you have:
- An ache in the centre of the wrist that has lasted more than six weeks without an injury to explain it
- Wrist pain with a normal X-ray that is not settling, which is a reason for an MRI
- Progressive loss of wrist movement
- Wrist pain while taking long-term corticosteroids
Early disease has options that late disease does not. If you have had surgery with us and have questions or concerns afterwards, phone the rooms during office hours on (08) 7127 0365.
Frequently asked questions
Is Kienböck's disease a type of arthritis?
Not at the start. It is a loss of blood supply to a bone, which is a different problem. Arthritis is the end result if the bone collapses and the joint surfaces around it wear, and most of what we do is aimed at preventing that.
Can the lunate recover on its own?
Sometimes, in stage 1 and early stage 2 disease, and that is the point of resting it. A repeat MRI after a period in a splint shows whether blood supply is returning. Once the bone has collapsed it does not recover its shape.
Why would you remove three bones from my wrist?
Because once the lunate has fragmented it cannot be rebuilt, and leaving it there means it keeps grinding on the joint. Taking out the first row lets the capitate sit in the socket of the radius and act as the new joint. The wrist is shorter and bends less, but it is comfortable and strong enough for most work.
Which operation will I have?
That is decided at your consultation, from your stage, your X-rays, the length of your ulna and the condition of the cartilage on CT or MRI. Some wrists suit one operation, some suit more than one, and where there is a choice we go through the trade and decide together.
When can I drive and go back to work?
Most people drive again once the fixed splinting stops, at six weeks after a proximal row carpectomy and eight to twelve weeks after a bone graft or radial shortening. Office work is usually manageable at two weeks, wearing the splint. Heavy manual work waits for three to six months. There is no legislation covering surgery and driving, so the test is whether you can control the car safely, including in an emergency. We will give you a realistic estimate for your job, and a certificate.
What does the surgery cost?
You will receive written informed financial consent setting out the surgeon, anaesthetist and hospital fees, your Medicare rebate and your health fund's contribution after your consultation and before anything is booked. Phone the rooms on (08) 7127 0365 if you have questions.
Do I need a referral?
Yes, for a consultation with one of our surgeons: a referral from your GP or another specialist. No referral is needed to see our hand therapists.
Written and clinically reviewed by Dr Paul van Minnen, MD, PhD, EBOPRAS, FRACS (Plast)
Last reviewed 8 November 2026