Hi;
I'm newly diagnosed with Kienbock's and my doctor is recommending a
proximal row carpectomy.  Seems kind of drastic, but he's telling me
that it's my best option to keep the most motion and strength.  I'm
experiencing moderate pain, but it's manageable with immobilization
anti-inflammatory over the counter medicine.  Has anyone had this
procedure?  Any thoughts?

sat in the chair, looked around the roo as usual... dr culp walks in, says
sooo.... show me wot uve got.  i make hand level w/ arm, thatsgood, next
move upward, i do wot i can, then he takes hand and moves it move, releases
and hand went back to where i last had it. ok  relax, takes a breath and now
yes u got it, move down. ok place elbow on table, brings up arm like if im
gonna arm wrestle sum1,lol. i let hand slowly move downward. i dont know the
degree u wod call it but if u were looking at a clock, finger tips point
to.....10 oclock , should be 8 oclock like left, but once wrist is in this
position, barbie can jump off the stiffest diving board , pmsl. sooooo.....
now he says hmmmm..... make a fist. ok i gave him eveything i had, made the
nicest fist, so proud............ok, great, bend it back,in fist,moves just
off the 12 oclock, no where near the 1, lol. (about 1/4 of an inch) ok, now
bend other way for me plz....well thats my biggest problem, see it dont move
that way. looks like it moves abit, but not noticeable.  then he did sum
rotating of the wrist and it cracks or pops, however u want to say it. i
told him of the many types of pain i have, and wot it is im doing that cuz
the pain. i get this pain over unla bone that spreads out to arm and fingers
making  a up n down motion, then  if i try the "open/ close jar" i get
stabbing pain over where the transfer to the thumb is. still get pin/needle
throughout the day. i tried to explain that the pain feels like its in the
bones, not the soft tissue, n the stabbing pains  feels like sumting
tearing. he also now thinks that arthrisis is setting in, like b4 injury, i
had no pains wot so ever. he did say "kath, u have a hand that can function
with sum limitations, u may not get back much more movemnt. the pain should
go away in due time, lets try working on getting ur hand and arm stronger
now.(at moment wrking with 3 lb weight, boy it hurts ,lol) so on this
tuesday i will have eval for work conditioning. oh n the funny thing about
therapy is that they seem to have just noticed that the wrist doesnt bend
downward, even after i mention (more than 7 times) that i cant,lol, they
were too busy worried about getting my palm up and fingers moving they over
looked that problem, also not much was done with thumb other then the
exerices they show me in the beginning, they did do sum stretching atfer
heat with the thumb. i have no problem with how the treatments are being
handled.just times they get so focused on 1 thing.
4 - 1/2 months after 2nd opt..... i feel like i know wots ahead of me, need
to face the fact that it wont be "normal" again. i try everyday to do things
that i havent been able to do, like starting car, wiping is still painful,
cant from behind, shoulder wont let me get arm back there but i try. washing
the dishes better now, still cant scrub hard. with everything else, the
right hand makes the effort to assist left hand in chores.

work, sounds odd to say that word, seeing i havent been there in 9 mos.
3 weeks ago called work to cash in last of vacation/sick/personal days
(seeing that wrk/comp dropped me, and disability pay ended,i was told i
could cash in, but after that there wont be anything else) .i was told had
to be 100% before i could return. they asked when i was coming back, told
them i will find out on the 5th of feb. that the dr hasnt said yet.that i
wod let them know after the appointmnt.
bad thing to do, work terminated me as of Jan. 31st. for "no show" of 3
consective days from day i called them,which is a breech of contract with
the union. i see that as very funny, seeing that the rules from being out on
disability states that i cant return if not 100%! just 1 more hurdle in my
life, making lawyer earn his money now,pmsl....still wont let self  cry over
it, it was expected.
i guess this is enof for me now.... love u all, try to have a pain free day,
kathy

Yo Big Lou, if your still on line i am in chat room now, cheers
mate,, Col

Congrats Col. Sounds successful to me. My scars were only an inch and a half
and I thought that was great.

john

[Non-text portions of this message have been removed]

Kienbocks Disease may be treated by immobilization, revascularization, ulnar lengthening or radial shortening, simple excision, limited intercarpul fusion, or salvage procedures.

Immobilization

Prolonged immobilization of the wrist has been tried in all stages of Kienbock's disease. In some cases it has shown to lead to continued collapse of the lunate. For Stage I, however, immobilization may be indicated in hopes that the vascular insult is kept to a minimum and that the lunate is given a chance to heal. Because diagnosis in this stage is often difficult, a trial period of immobilization may result in characteristic radiographic changes that establish the diagnosis.

Revascularization

In stage II Kienbock's Disease, before the lunate has collapsed, it is possible for the lunate to regain blood supply.

One procedure is which a small piece of volar radial bone, still attached to the pronator quadratus muscle, is grafted to the avascular lunate. This procedure is done through the volar approach with division of the palmer and transverse carpul ligaments in order to mobilize the median nerve. After the volar wrist is entered the lunate is burred with a high speed drill in preparation to receive a 1 to 1.5 cm piece of radial bone still attached to the pronator quadratus muscle. This is secured with pull out wires or clips.

A similar revascularization procedure uses the pisiform. Pisiform transfer on its vascular pedicle. Has found uniformly good results

Another is described as direct transplanting of a vascular bundle into the vascular lunate, with successful results.

It must be remembered, however, that none of the revascularization procedures are likely to work in the face of severe collapse (stage III), for even if they are successful in re-establishing blood supply, lunate height and normal carpul kinematics will not be restored.

Ulna Lengthening and Radial Shortening

On the basis of the theory that ulnar minus variance is a significant etiologic factor in Kienbock's Disease, some have advocated equalization of the distal articular surfaces by either ulnar lengthening or radial shortening. Both procedures have had good results reported. However, it seems unlikely that leveling of the distal articular surfaces of the lunate can restore an already collapsed lunate. These procedures remain questionable in advanced stage III.

Both radial shortening and ulnar lengthening require osteotomy. A segment of bone is removed when radial shortening is done and a segment of bone graft inserted when ulnar lengthening is done. After either, fixation is usually accomplished with a compression plate. It is generally recommended that the ulnar variance be changed to 1 to 2 ml positive variance by placing an appropriate sized interpositional graft during ulnar lengthening.

Radial shortening may be preferable to some because it does not require a second surgical incision to harvest bone graft.

Excision of the Lunate

Lunate excision was one of the first surgical procedures for Kienbock's Disease. The rational of this procedure is to remove sequested bone that is provoking painful synovitis. Some have reported good results from simple excision others critize the procedure predicting late proximal migration of the capitate.

Limited Intercarpul fusion

Its most important advantage is that radiocarpul motion is maintained, unlike with complete wrist arthrodesis.

Patients with severe fragmentation of the lunate undergo resection of the necrotic bone, osteotomy of the capitate in its mid portion, and proximal displacement of the proximal capitate fragment, which is secured to the scaphoid and triquetrum with bone pegs. Essentially, the space vacated by excision of the lunate is filled by the proximal half of the capitate fragment, and the space left by osteotomy of the capitate is filled by autogenus bone graft. The procedure is then completed by performing arthrodesis of contiguous surfaces of the hamate, capitate, scaphoid and triquetrum by first denuding articular surfaces and securing the bone with small cortical bone pegs. When the lunate remains suitably intact, osteotomy of the capitate is omitted, as is lunate excision, and the contiguous surface of the lunate, scaphoid, triquetrum, hamate and capitate are arthrodesed.

Different predisposed risk factors have been implicated in the development of this Disease. The most commonly cited factors are the interruption of the blood supply to the lunate, negative ulnar variance, and the workplace environment. These factors, as well as how to minimize the risk for developing this disease will be discussed in the following paragraphs

Stahl believed that in a lunate with an already tenuous blood supply, traumatic compression fracture leads to avascular necrosis.

Lee found three vascular patterns in lunates from cadavers: a single vessel, either volar or dorsal, supplying the entire bone; several vessels at both volar and dorsal surfaces of the lunate without central anastomosis; and several vessels at both volar and dorsal surfaces of the lunate with central anastomosis. Therefore according to Lee, patients with the former two patterns are at greater risk for developing Kienbock's Disease.

In fresh specimens, Gelberman and associates also studied the extraossoeus and intraosseous blood supply of the lunate. They found that in intraosseous blood supply consisted from three patterns : Y in 59%, I in 31%, and X in 10%, with dorsal and volar anastomosis just distal to the center of the lunate. Evaluation of the terminal vessels in the lunate allowed Gelberman and associates to conclude that the proximal subchondral bone, adjacent to the radial articular surface, was least vascular. Because of the rich extraeossis blood supply, they discounted the theory held by some that interruption of vessels entering a single pole of lunate caused avascularity. Based on the work, Gelberman and co-workers suggested that it is intraosseous disruption of vascularity, owing to repeated trauma with compression fracture, that cause Kienbock's Disease.

Negative ulnar variance as a risk factor has received considerable attention from the research community. In 1928, Hulton noted that a short ulnar was present in 78% of his patients with Kienbock Disease, where as only 23% of normal patients had a short ulnar. He called this condition ulnar minus variant. Since the condition was first discovered, many authors have confirmed negative ulnar variance in patients with Kienbock's disease.

Theoretically, a short ulnar variance, relative to the distal articular surface of the radius, causes increased shear and compressive loads on the lunate. Elaborate studies by Werner and associates proved that altered load transmission through the radial carpal joint with ulnar minus variance predisposes the radiolunate articulation to increase loads. This is thought to be a contributing factor in the development of Kienbock's Disease.

Until recently, Hulton's findings have been confirmed by many investigators but has been questioned by others. To date, this controversy has not been resolved. To make matters more complicated accurate measurement of ulnar variance is not simple. As pointed out by Epner and Palmer, the apparent variance changes with the position of the arm.

With this in mind, Palmer and associates further standardized the method for determining ulnar variance. They found the position of the distal ulnar, in relation to the distal radial surface changes with varying degrees of forearm rotation and that the change in variance was least with the elbow fixed at 90 degrees, The standard view recommended is a poster anterior wrist radiograph obtained with the patient's shoulder abducted 90 degrees, the elbow flexed 90 degrees, and the forearm in neutral rotation. The importance of accurate measurement of ulnar variance is highlighted by the recent gain in popularity of ulnar lengthening and radial shortening techniques to treat Kienbock's Disease

It appears the effect of aging on ulnar variance supports the theory that negative ulnar variance is a predisposed risk factor in the development of this disease. It has been shown by several researchers that ulnar variance increase with age. The cause of the increase of ulnar variance with aging is unknown, but it might be due to shortening of the radius because the force of the forearm muscle is mainly transferred to the radius to developing Kienbock's Disease.

Although Kienbock's Disease mostly affects young, active males, usually in the 3rd or 4th decade of life, Yoshida reported that of a 127 cases reviewed, 15 patients were found with aged onset. Among these 15 cases women predominated. This is a striking difference from Kienbock's Disease in young adults. Other findings reported from that study revealed that symptoms in elderly are usually not so severe and conservative treatment is typically effective. It was also shown that the degree of negative ulnar variance was not as great as in the young effected population. Several other researchers have shown that the degree of negative variance is greater in males than in females. This supports the findings that males are more susceptible.

Besides the anatomical and biological factors, the workplace also has been implicated as a contributing factor to the advancement of this disease. Occupations which require the use of pneumatic tools such as a rivet gun and hammers are all at particular risk for the development of Kienbock's Disease. The increased impact loading upon the wrist is thought to be a catalyst for the disruption of the blood supply to the lunate ultimately leading to its demise. The etiology of Kienbock's disease is thought to be either repeated minimal trauma or by a single acute episode. The underlying theme behind the theory of repeated minimal trauma is repetition coupled with force. Both established Cumulative Trauma Disorders (CTD) risk factors have been recognized as potentially harmful elements to the musculoskeletal system. The other proposed etiology, a single acute episode, indicates that force may be of greater importance. In either case, ergonomist must evaluate these factors carefully when designing or redesigning the workplace.

Wrist posture has been indirectly implied as another possible risk factor for the development of Kienbock's Disease. In two separate studies, individuals with cerebral palsy were evaluated because they have a high muscle tone, which is essentially repeated trauma, and the radiocarpul joint is constantly exposed to considerably higher pressure than what is found in normal individuals. Rooker and Goodfellow found five cases of kienbock's Disease in a group of 53 adults with cerebral palsy. An abnormally flexed wrist posture was a common feature in all five cases. This suggested to them that this extreme posture compromised the blood supply to the lunate and was considered a contributing factor to the development of Kienbock's Disease. In a more recent study, Joji reported that there is increased pressure between the radius and lunate due to the dynamics conditions so excessive muscle tone characteristics of cerebral palsy. The resting posture of their subjects was predominantly ulnar flexion with one case of volar flexion. Joji and associates went on to conclude that it was unlikely that volar flexion was the cause of Kienbock's Disease. However, in both studies a resting deviated wrist posture was observed. It is therefore possible that deviated wrist postures, incorporated with other risk factors could lead to the development of Kienbock's Disease.

It appears that the dominant hand of the worker is at the greatest risk for developing Kienbock's Disease. This finding is consistent with the etiology. In fact, the majority of the time Kienbock's Disease is unilateral.

Like many other Cumulative Trauma Disorder's, Kienbock's Disease can be treated by various medical interventions. Many of these interventions will relieve symptoms but if the individual is returned to similar activities it is possible to see a reoccurrence of Kienbock's Disease.

Kienbock's Disease is diagnosed radiographically. The characteristic changes of the lunate include increased density, fracture lines, fragmentation, and progressive collapse of the lunate.

It should be distinguished from other causes of wrist pain and swelling particularly in the early stages.

Disorders to rule out include rheumatoid arthritis, post traumatic arthritis, synoval based disease, acute fracture, carpul instability, and ulnar abutment syndromes. The radiographic hallmark of increased density seen typically in Kienbock's disease should be distinguished from transient vascular compromise.

Once the Diagnosis of Kienbock's Disease is established, the degree of involvement should be determined in order to assist you through the many treatment options. Casting for 2 to 3 weeks in uncertain cases will usually reveal the diagnosis by relative disuse osteoporosis of the adjacent carpul bones.

click back to return to KD information

"The Disease you never hear off or you have never heard off, until you get it".......( Col Pickering )

Avascular Necrosis of the Lunate

n: osteochondrosis affecting the lunate bone - called also lunatomalacia.

Basically, the blood supply to the lunate bone shuts off, which causes the bone to die, with eventual collapse of the lunate bone.

As this is a RARE DISEASE little is known about its causes.

KIENBOCK ROBERT ( 1871-1953 ) Austrian Radiologist.

Kienbock pioneered in Radiology. From 1910-1911 he published descriptions "Concerning Traumatic Malacia of the lunate and its Consequences : Degeneration and Compression Fractures", descriptions of dislocations of the hand and a slowly progressive Chronic Osteoitis involving the Lunate Bone.

Kienbock described the process of Lunatomalacia both the Radiographic changes seen with the disease, and the clinical symptomatology that accompanied it.

Radiographically, Kienbock described various changes in the lunate with the vast majority of cases beginning the disease in the proximal portion, preserving the distal portion articulating with the capitate. In some radiographs, the shape of the lunate was preserved and only the internal structure was altered, with radiographs demonstrating areas of increased intensity. In most radiographs, however, with the progression of the disease, the shape of the lunate was significantly affected with the destruction of the proximal portion and loss in height of the bone.

Kienbock noted that the disease usually occurred in men in their thirty's and forty's who were heavy labourers. Frequently they would have an antecedent trauma with negative radiographs and were diagnosed with a sprain. Overtime, the clinical course would progress with pain, swelling and restricted motion of the wrist. Percussion of the third metacarpal ( the hand held in a fist ) produced pain in the lunate region and when comparing hands shortening of the carpus might be evident.

Radiographs demonstrated radiographic changes in the lunate and loosening of the radiocarpul joint, which Kienbock thought promoted mechanical damage. This loosening probably referred to the increased radiocarpul space due to synovitis, proceeding radiocarpul arthrosis.

Kienbock favoured the view that the condition was due to a disturbance in the nutrition of the lunate, caused by a rupture of the ligaments from a sprain or sublixation. Leading to, rather than being a result of compression fractures.

Kienbock believed that recovery from this disturbed nutrition only occurred in acute cases, and in late cases, it could be treated only by removal of the lunate.

Usually at surgery or on a post mortem examination, the lunate was found in two fragments, as previously described by anatomist's, one volar and one dorsal.

Now known to be 'Kienbock's Disease'

Click on back to return to KD Info

Kienbock's Disease follows a specific progressive pattern which is formed into stages.

Initially, in the early phases of Kienbock's Disease, the changes are localized to the lunate. In these phases, radiographs reveal increased density, which progresses to lunate collapse. In the later phases, the pathology involves the mechanical structure and kinematics of the wrist, not just the lunate. In the more severe disease, the proximal widens, and rotatory instability of the scaphoid and diffuses degenerative changes occur.

Stage I

In this Stage, radiographs are normal except for the possibility of a linear or compression fracture that may be shown on tomography. In this phase, bone scan usually is abnormal, and magnetic resonance imaging (MRI) is currently diagnostic.

It should be noted that MRI was not available for the diagnosis of this disorder when this classification was devised. Many have suggested that Stage 0 should be added for those cases in which MRI changes are the only diagnostic clues. It should be clearly understood that these cases fit into Stage I.

Stage I was a stage awaiting a diagnostic tool. In fact, Litchman states in his paper that "radionucleide scanning in stage I may be abnormal, and refinements in current techniques may soon permit reliable early diagnosis.

Stage II

Disease in this Stage is still localized to the lunate. The size, shape, anatomic relationship, and kinematics of the carpal bones are not significally altered. The lunate has a definite increased density relative to the other carpal bones. Late in this Stage, some bone height may be lost on the radial side of the lunate fracture that may be shown on tomography. In this phase, bone scan usually is abnormal, and MRI is currently diagnostic.

Stage III

This Stage is the transitional one in which the disease begins to affect the carpal structure and kinematics. At this point, the lunate has collapsed in the frontal plane and elongated in the sagittal plane. The capitate begins to migrate proximally. Foreshortening of the scaphoid (the ring sign), scapholunate dissocation, and ulnar deviation of the triquetrum may or may not be present radiographically. Measurements of the carpal height ratios, or the lunar perimeter and lunate area indices, help determine the degree of carpal collapse.

This transitional Stage is divided into Stages IIIA and IIIB. In Stage IIIA, lunate collapse occurs without fixed scaphoid rotation and other secondary derangements.

Stage IV

All the findings of Stage III are present as well as generalized degenerative changes in the carpus. The surface of the adjoining bones affected resulting in generalized inter-carpal arthritis in the wrist.

In stage IV Kienbock's Disease, good results have been reported with Proximal Row Carpectomy (PRC) and wrist arthrodesis (total fusion).

Choice between the two procedures is determined by the needs and desires of the patient and the integrity of the articular surfaces of the lunate fossa and the capitate.

Proximal row carpectomy should be reserved for those people who desire motion over strength, whereas the wrist fusion is preferable in those people who need strength. Total wrist arthroplasty is generally contraindicated in young active people. Treatment choice must be based on a number of variables, including the experience of the surgeon, the desires and activity level of yourself.

In the early stages, efforts should be made to salvage the lunate and prevent loss of normal architecture. In the later stages, efforts should be made to restore that architecture. In the end stage, normal architecture must be sacrificed to restore function.

PROXIMAL ROW CARPECTOMY:

Excising the proximal carpal row so that the capitate articulates with the lunate fossa on the radius is rarely indicated, as the capitate and radial articulations are almost invariable damaged by the disease process to the lunate. However, the procedure can produce good results in carefully selected cases of wrist arthritis where the two key articular surfaces are considered to be satisfactory on radiographic assessment. The proximal carpul bones are excised through a dorsal approach with dorsal capular repair. The wrist is rested in a cast in neutral flexion/extension for 4-6 weeks and the mobilized. Power and movement are only slowly regained but the patient usually obtains 40-60' of flexion/extension range around the neutral point with moderate grip strength one year after surgery. If the key articular surfaces were in satisfactory condition pre-operatively, reasonable pain relief is obtained.

ARTHRODESIS of the wrist.

Fusion of an osteoarthritic wrist is most commonly obtained by the use of a plate and screws to radius, carpus and third metacarpal, augmented with cancellous bone graft. Slight dorsal angulation potentiates grasp. The dorsal incision extends to the radius, retracting the extensor indicis proprius compartment radially and the extensor compartment ulnarly. The dorsal two thirds of the articular surfaces of the wrist joint are rawed and the cavitates packed with cancellous bone. Modern low profile plates and screws are not unduly prominent, and there is normally no need to remove the metal work unless discomfort is experienced. The stability of the fixation is such that the fingers and the thumb can be mobilized immediately. The dissection can largely avoid direct exposure of the extensor tendons, reducing the risk of tendon adhesions.

DENERVATION of the wrist.

No attempt is made to treat the arthritis, simply the pain that it causes. The nerves that supply the carpus are classified into radial, median and ulnar groups, and a serial nerve blocks will reveal to an extent the likely result of ablation of these various nerves. An extensive long term study has shown it to be useful in reducing pain but retaining movement, apparently without the risk of a Charcot joint. ninety per cent of these series were considered to have gained reasonable pain relief (60% pain free and 30% improved).

OPERATION DETAILS

(44 year old patient0

(P2) Bilateral Wrist Denervation / 3 Incisions on each wrist / 2 Dorsal Incisions / 4th & 5th Compartments / Posterior Interosseous Nerve divided / Branches of Ulnar Nerve divided / Volar Curved Incisions / Radial Nerve and Vessel Branches divided / Anterior Interosseous Nerve and Branches Identified and divided / 20mls Ropivacaine to each wrist / Vicryl Fat / Nylon Skin / Jelenet/Melolin/Wool/Crepe

POST OP COMMENTS - Elevate / Home / Reduce dressing 72 hrs / Out Patients Review 2 weeks

click back to return to KD Info

Kienbock' Disease is an isolated disorder of the lunate resulting from vascular compromise to the bone. The symptoms include wrist pain, limited range and motion, and decreased grip strength.

Kienbock's Disease presents in various forms. The changes in the lunate may be very localized or diffuse. With progression, the lunate may fracture into two pieces or crumble into granules or produce an osteochondral fracture from one surface.

The cartilage is not primarily involved in the pathogenesis and remains relatively healthy. Bone death occurs over time. Often, a symptomatic wrist will demonstrate normal X-rays with the diagnosis evident only on MRI. The degree of loading of the wrist appears to be important and changes in the lunate are cumulative.

Additional fault plates may form in other areas of the lunate. This phenomenon is probably present in most of our carpul bones, but time and avoidance of similar overload injuries preclude development of multiple plates. Areas in the lunate reach a critical state in which either a small section or most of the bone becomes relatively walled off by multiple fault plates and further normal injuries can no longer heal effectively because the capillary blood supply is inadequate. Causing the bone to die, providing a significant area further limiting vascular access.

Changing one or more of the aetiological factors can halt progression and the necrosis areas walled off by fault plates can probably heal. Collapsed areas, however, remained deformed.

Most cases of Kienbock's disease develop, then, as a result of a long process of insult which is multifactorial in etiology, producing overload within the substance of the bone. In the susceptible lunate, miniplanes of injury result in relatively avascular fault plates, gradually sectioning off areas in the lunate. Healing in these small areas cannot occur quickly enough if the abnormal loads and demand continue, ultimately resulting in areas of cell death.

POSTING MESSAGES:
If you are posting messages to the group as a member, could I ask you to post to KienbockDisease_Australia@yahoogroups.com Or just click on post in group home page.
Non members please email: KienbockDisease@...

CHAT ROOM:
Letting all members know that there is regular CHAT SESSIONS Tens times a week at http://groups.yahoo.com/group/KienbockDisease_Australia/Chat. For Real Chat times refer to Kienbock Disease Australia Chat memo. It would be good to see more members in the chat room as it is a fast way of gathering information, or even if its to get something off your mind, we also have a bit of a laugh with each other as well.

FILES:
If you have any information you would like to share, you can list them in Files section. Also I am currently storing stories for Kienbock Disease The Real Story

PHOTOS:
If you have any x-rays or photos you wish to share you can place them in the Photo section.

DATABASE:
The Database has member contact info in it. You are welcome to leave your details there if you wish.

POLLS:
Letting all members know that there are some Polls running and I ASK ALL MEMBERS to fill in these POLLS as it gives us an idea as a group the differences between our condition of Kienbock's Disease. I also ask all members to update these POLLS every six months, because as time goes by, so does your condition change and the operations you may have. All Polls are strictly confidential.

EDIT MEMBERSHIP:
If you change your email address, I ask all members to edit that information on their membership details, thankyou.

CALENDAR:
If you have any useful happenings? (operations, birthdays etc...) you can mark them in the Calendar Also chat topics for the week can be found here.

This Information is only available to group members, as non members can only access the home page.

Once again I welcome all new members, and one day the answer to that question we seek." How and why did I get Kienbock's Disease ?" may be answered.

Col Pickering
Group Owner/Head Moderator
Email: KienbockDisease@...

Assistant Moderator's
Adrian (Aust), Melodie (Partners), Toni (USA), Jay (Canada) and Birgit (Europe).

Disclaimer

All references to the subject 'Kienbock's Disease' is from members
own personal experiences or personal research done by members.
It should never be taken as 'yes' this will fix me, but we will give you
options of what is available, specialist's in your location to see etc...
and what to look forward to into the future from past experience's.

Advertising in this group is not Permitted.

Uploading of files must be approved by the Group Owner or Assistant Moderators.      

Col Pickering 

Group Owner/Head Moderator KienbockDisease_Australia KienbockDisease@...

Adrian - Assistant to Head Moderator and Australia / Toni - Assistant Moderator USA / Jay - Assistant Moderator Canada / Birgit - Assistant Moderator Europe UK / Melodie - Assistant Moderator Partners of a KD'er

Hi there Gang,

I just wanted to let you know that the KD OZ Chats have been such a big hit, so much so that many of us have been in there everyday/night and for many hours.

So I wanted to let you know that if you have any questions or concerns that you would like to address right away... or if you would like to just have a chat, come on in see if someone is there... any time of day or night, 7 days a week, don't be shy.

Hugs to you all,

Melodie

(KD OZ Assistant Moderator)

The main thing is that everyone feels welcome and free to express themselves in their posts or while in the chat room. However everyone needs to remember that this is a community of people that may not share the same beliefs, lifestyle or philosophy on life, e.g. politics and religion, as each to their own.

Please respect other people and their beliefs.

Management of this group find it acceptable for someone to send good wishes like 'god bless' or similar and if the person this is addressed to does not share the same beliefs then it is best to take this statement at face value:- "as a good wish". 

Please send feed back to adrian554au@... all feed back will be kept confidential, Thank you.

Adrian : Assistant to Head Moderator
adrian554au@...
Kienbock Disease Australia Support and Information Group

i use the wax 3 times a week, only to loosen up the tendons, ligaments and
muscles b4 execising the wrist and fingers.
Col, hope ur feeling better, do u need my meds?, take care,
kathy

>From: "Col Pickering" <KienbockDisease@...>
>Reply-To: KienbockDisease_Australia@yahoogroups.com
>To: <KienbockDisease_Australia@yahoogroups.com>
>Subject: Re: [Kienbock Disease Australia] (unknown)
>Date: Mon, 31 Jan 2005 14:07:20 +1000
>
>Hi and Welcome to the group.
>
>Exogen,. yes I have heard of it but not sure if any member is using it.
>Paraffin Wax, yes I have had the wax treatment, it feels great for a while
>but in reality it didn't do anything for my KD, it may sooth the pain for a
>short while.
>My tip for pain control, is that I have had a bilateral denervation, once
>again it does nothing for your KD, but it has brought my pain level down
>from a 8-9/10 to a  2-3/10.
>As KD is a rare Disease you will find it hard finding a doc or specialist
>who has seen a lot of cases of KD.
>Where are you located? There may be a member in your area who is seeing a
>good doc or specialist.
>take care
>
>Col
>
>
>
>
>----- Original Message -----
>From: "korach55" <korach55@...>
>To: <KienbockDisease_Australia@yahoogroups.com>
>Sent: Monday, January 31, 2005 11:03 AM
>Subject: [Kienbock Disease Australia] (unknown)
>
>
> >
> >
> > Hi,
> > Has anyone heard of or used a treatment called EXOGEN? It is
> > normally used to speed up the healing time for fractures. Has anyone
> > used this before, was it successful? Also, has anyone used parrafin
> > wax to help with pain? Any tips to help control the pain?
> > Also...has anyone's doctor seen lots and lots of patients with
> > kienbock's disease? It seems as if it is a very rare disease, so our
> > doctor only sees about 4 patients a year.
> >
> > Many thanks...
> > Take care
> >
> >
> >
> >
> >
> >
> > Kienbock Disease Australia Support and Information Group.
> > A Friendly Support and Information Group. Our Aim is to help all people
> > who have been Diagnosed with Kienbock's Disease Understand and how to
>Deal
> > with Kienbock's Disease.
> > Post for information to KienbockDisease_Australia@yahoogroups.com or
>Join
> > in the Chat Room,
> > http://groups.yahoo.com/group/KienbockDisease_Australia/chat
> > No matter where you are from your input is important and welcome.
> > Email Group Owner : Col Pickering email:
> > KienbockDisease@... with your comments or further
> > assistance.
> >
> > Yahoo! Groups Links
> >
> >
> >
> >
> >
> >
> >
> >
>
>

Hi Col,
Glad to see and hear that you are doing so well. I did not realize  the
keyhole surgery spots were so small. That was wonderful for you i can only
imagine.
Wishing you a speedy recovery.
Love ya
Toni


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