Jackie,
Congratulations on your job I knew you could do it. I got some great news
myself. The scum that almost killed us went back to the Grand Jury and once
again they are charged with 1st degree assault. I am so happy. But I do with it
was attempted murder. Once again I am so proud for you. Just do not do to much
  with you hand.
Love ya bunches!!!!
Toni


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

Jackie

Congratulations on your new job!!  That's wonderful news.  Hope  it all works
out for you - you certainly deserve it after all you've been  through!!

Cheers, mate!

Love

Jeanne

Through this toilsome world, alas!
Once and only once I  pass;
If a kindness I may show,
If a good deed I may do
To a suffering  fellow man,
No delay for it is plain
I shall not pass this way  again."


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

Hi Jackie,

   Did you get my text ok today?  Was so pleased to hear your good news and
things are definatley looking up for you now.......... you'll be a different
person now you have other things to occupy your mind and time outside of home.

   You can come and visit us anytime hun... but not this weekend as we are going
to Bristol for my mum's birthday so wont be back til Sun haha.

   Anyway you take care and good luck for Monday and let me know how you get on.

   Hi to everyone else Ive not managed to catch up with for a while, been
studying and turning my messenger off so I dont get interupted.

   Hope everyone is well and not in too much pain and I wish you all a good
Easter and Pain free days

   Love

   Fiona

JACKIE <redlippedwoman@...> wrote:
   Hello everyone

I start work Monday am so excited 2nd job interview and i got the job
so now i can start looking to rent a house and move on with my
kids!!!  I also have a car too so things are atlast moving on so can
stop moaning about how crap things are for five mins haha

Hello to Toni, Jean and Fiona hope you all are doing ok .

For the first time in a long time i am hopeful that maybe things can
work out ok after all.

anyway will let you know how i get on take care and will speak soon.

lotsa love all

jackie

xxxxxxxxxx






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.
HAVE A PAIN FREE DAY




---------------------------------
   YAHOO! GROUPS LINKS


     Visit your group "KienbockDisease_Australia" on the web.

     To unsubscribe from this group, send an email to:
  KienbockDisease_Australia-unsubscribe@yahoogroups.com

     Your use of Yahoo! Groups is subject to the Yahoo! Terms of Service.


---------------------------------





---------------------------------
Yahoo! Messenger  NEW - crystal clear PC to PC calling worldwide with voicemail

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

welll had the neurostimulaotr put in for close to a
month now. since surgery pain has been gone i feel a
ton better. it cut the pain in half at least. am very
pleased and satsfied. i had it done my a dr that has
clients coming from three states over to see him. good
credentials!!!make hand jump is only thing thta
bothers me about it but otherwise ... its a great
choice to pain managment


hope you all have a pain free day
andy

__________________________________________________
Do You Yahoo!?
Tired of spam?  Yahoo! Mail has the best spam protection around
http://mail.yahoo.com

Hi Jackie,,,such wonderful news re your job and a much better looking future.
   My MRI results were not clear so now I am having a CT Scan next week,,the
surgeon is really fumbling in the dark i feel. He keeps saying, this is very
unusual,,,yeah,,isn't it????????????? Not what i want to hear at this stage and
as for the physio,,,hmmmm well I suspect it's not doing one bit of good,,,anyway
let's hope for better days,,,,so happy you can now move on,,,Carol

JACKIE <redlippedwoman@...> wrote:
   Hello everyone

I start work Monday am so excited 2nd job interview and i got the job
so now i can start looking to rent a house and move on with my
kids!!! I also have a car too so things are atlast moving on so can
stop moaning about how crap things are for five mins haha

Hello to Toni, Jean and Fiona hope you all are doing ok .

For the first time in a long time i am hopeful that maybe things can
work out ok after all.

anyway will let you know how i get on take care and will speak soon.

lotsa love all

jackie

xxxxxxxxxx






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.
HAVE A PAIN FREE DAY

Yahoo! Groups Links










---------------------------------
Talk is cheap. Use Yahoo! Messenger to make PC-to-Phone calls.  Great rates
starting at 1&cent;/min.

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

Thanks Toni,

Just wondering if my wrist is weak and occasionally extremely sore
and have all the symptoms described for KD is it a case that my wrist
will just begin to get worse and the pain becomes increasingly more
consistent??


--- In KienbockDisease_Australia@yahoogroups.com, Treeves321@...
wrote:
>
> Jamie,
> Sorry I have not been on line for a few days. I have had a all the
way to a
> total fusion (3 surgreies on my left hand) now I am facing the same
problem on
> my right hand and should find out soon what stage. I will be glad
to answer
> anything I can. We are all here for support. Again I am sorry. Let
me know if I
> can help in any way.
> Your K.D. family
> Toni
> Treeves321@...
> or Treeves321@...
> U.S. Moderator for Australia
>
>
> [Non-text portions of this message have been removed]
>

Hiya jamie

I had had pain in my right wrist since i was early 20's am now 34 it
was only about 3 years ago that i was actually diagnosed with kd.  I
have had physio over the years so it was a relief to know what was
wrong.  Unfortunately when they diagnosed me i was in stage 4.  My
doctor is Mr Shah at Kettering General Hospital and he knows his
stuff ( i hope) he put a camera in my wrist in 2004 and took out
alot of bone fragments and he hoped by doing this it wouldn't be so
painful but it was and the occupational therapy i was having wasn't
doing alot, he thought the pain was stopping me move my wrist, so in
Jan this year he did a stt fusion, denervation and lunate removal.
I am taking less painkillers instead of taking 2 slow release
Tramadol, 8 paracetomol and codein and anti inflammatories a day am
just taking the tramadol and maybe a couple of paracetomol.  The
best bit is i have just got myself an automatic car and a job i
havnt been able to do either for over 4 years.  Hopeing i can do the
job but need to really as am just in the process of separating with
my husband.

The best advice i can give is if your wrist is really sore rest it
as much as you can, i don't always follow my own advice and then i
end up with a really badly swollen hand, but am trying.

I had to push to have the second operation done but read as much as
you can for whatever stage you are at, my surgeon joked i could do
the operation myself as i knew all about everything i had done but
it really does help to be informed.

Anyway write if you wanna know anything take care mate

Jackie

xxxxx

Hello everyone

I start work Monday am so excited 2nd job interview and i got the job
so now i can start looking to rent a house and move on with my
kids!!!  I also have a car too so things are atlast moving on so can
stop moaning about how crap things are for five mins haha

Hello to Toni, Jean and Fiona hope you all are doing ok .

For the first time in a long time i am hopeful that maybe things can
work out ok after all.

anyway will let you know how i get on take care and will speak soon.

lotsa love all

jackie

xxxxxxxxxx

Hello,

This email message is a notification to let you know that
a file has been uploaded to the Files area of the KienbockDisease_Australia
group.

   File        : /Kienbock Disease Information/TFCC.mht
   Uploaded by : kienbockdisease <KienbockDisease@...>
   Description :

You can access this file at the URL:
http://groups.yahoo.com/group/KienbockDisease_Australia/files/Kienbock%20Disease\
%20Information/TFCC.mht

To learn more about file sharing for your group, please visit:
http://help.yahoo.com/help/us/groups/files

Regards,

kienbockdisease <KienbockDisease@...>

THANKS jUDY

I will put into group files
thanks

Col
   ----- Original Message -----
   From: jmschneck
   To: Col Pickering
   Sent: Wednesday, April 05, 2006 1:18 PM
   Subject: Some KD Info


   Col,
   You may or may not have some of this but if you think any of it is helpful to
others, can you put it in a file? Maybe especially the radial osteotomy-it's
what I had.
   Hope all is well,
   Judy

    TFCC-DRUJ PROBLEMS

   TFCC/DRUJ PROBLEMS
   Introduction
   A common cause of wrist pain is damage or degeneration of the Triangular
Fibrocartilagenous Cartilage Complex (TFCC) or triangular cartilage for short.
The TFCC sits on the end of the ulna bone (see hand bones) and has two roles
normally. It helps to hold the radius and ulna bones together. It also transmits
about one third of force passing across the wrist from the hand to forearm. TFCC
problems can occur independently or in combination with those affecting the
distal radio-ulnar joint (DRUJ). Combinations may result from wrist fractures.




   When the TFCC is torn or damaged, it is usual to get pain on the ulnar side of
the wrist. This occurs particularly during the twisting movements that are
called pronation and supination. Patients also may experience clicking or
popping sensations during movement.

   The detection of TFCC problems is made more difficult as the cartilage is not
visible on conventional radiographs. Diagnosis requires experience, a high level
of suspicion and specialist investigations. Whilst the TFCC can be visualised by
special X-Rays (arthrograms) and Magnetic Resonance Images (MRI), the optimum
method is arthroscopy. This permits direct visualisation as well as
intervention.



   ARTHROSCOPY

   Arthroscopy involves placing a small telescope into the wrist joint(s). The
telescope is inserted into at least two areas on the back of the wrist. The view
is projected onto a television screen. This allows me to inspect all the joint
surfaces and the wrist ligaments. Usually the procedure is purely for diagnosis.
Sometimes it can be combined with the removal of loose fragments or trimming of
cartilage tears. I will not proceed to an "open" operation unless this has
previously been discussed with you. The operation is performed under general
anaesthetic but you can usually be discharged on the day of surgery. It is usual
to be able to return to your normal activities within days of the operation
unless additional procedures have been performed.

   Complications

     a.. Scar You will have 2-3 small scars on the back of the wrist. These will
be somewhat firm to touch and tender for 6-8 weeks. This can be helped by
massaging the area firmly with the moisturizing cream.
     b.. Nerve damage Nerves running in the region (see diagram) can be damaged
during the surgery. This would cause the formation of a painful spot in the scar
(neuroma) or a small area of loss of sensitivity on the dorsum of the hand. This
complication is rare (4%) but may require a further operation to correct.
     c.. Infection Superficial infection (3%) can occur after any operation and
would be treated with antibiotics. Deeper infection, involving the joint is very
rare.
     d.. Tendon damage The tendons running to the fingers can be damaged or cut.
This is very rare (1%) but would require further surgery to correct.
     e.. Stiffness About 5% of people are sensitive to hand surgery and their
hand may become swollen, painful and stiff after any operation (algodystrophy).
This problem cannot be predicted but will be watched for afterwards and treated
with physiotherapy.





   TREATMENT

   The picture above shows a 1mm diameter probe being placed in a TFCC tear. It
is usually impossible to repair a damaged TFCC except in the first few weeks
after an injury. Treatment is therefore often aimed at reducing symptoms by
unloading the TFCC. The treatment of these problems is tailored to individual
patients. It is influenced by the level of symptoms experienced and factors such
as the relative length of the radius & ulna (ulnar variance) and the state of
the DRUJ. The treatment options available are:

     a.. Acute TFCC tear - Open or arthroscopic repair if significant,
debridement (tidying) if small.
     b.. Old TFCC tear/degeneration + normal DRUJ - Debridement + shortening
osteotomy.
     c.. Old TFCC tear/degeneration + unstable or degenerate DRUJ - Debridement +
Sauve Kapandji.


   ULNAR OSTEOTOMY

   The operation involves a cut on the wrist to allow access to the bone. Two to
three millimetres of the ulna are removed. The bone is then held together by a
plate.




   The operation is performed under general anaesthetic. You will stay in
hospital for one night after your operation. Your hand will be placed in a bulky
dressing which includes a plaster to protect the operation. Movement of the hand
should be continued.

   The day after the operation, your plaster will be changed to a lighter splint.
At this stage, you can carefully remove your splint in the day. It is permitted
to perform very light activities and your exercises. The splint should be worn
at night or in situations where the operation site may be knocked (shopping, in
the street, children running about). Heavy unprotected twisting movements should
be avoided (steering wheel, screw-driver, bottle opener) as this puts great
stress across the plate.

   An X-ray will be performed after six weeks to check if the bones are joining
(uniting). The surgeon will also gently stress the osteotomy to assess this.
Lessening tenderness indicates good progress. At this time, you will need to
wear the splint less and you will be able to do more. You will be advised about
this but common sense will guide you (i.e. if it hurts, stop doing it!). The
bones unite quite slowly. It will be 12 - 16 weeks before you can consider a
return to heavy activities.

   You must remember that the operation does not cure the TFCC problem. It is
only hoped to reduce the pain but it will not abolish your symptoms. There may
be other problems in the wrist joint which also cause pain. These will have been
discussed before surgery.

   Complications

     a.. Scar You will have a scar on the side of the wrist. It will be somewhat
firm to touch and tender for 6-8 weeks. This can be helped by massaging it
firmly with the moisturizing cream.
     b.. Infection This can occur after any operation and would be treated by
antibiotics.
     c.. Nerve damage A small nerve running in the region can occasionally be
damaged during the surgery and either cause numbness on the back of the hand or
form a painful spot in the scar (neuroma). The latter complication may require a
further operation to correct it.
     d.. Delayed or non- union Union of the bone can sometimes be slower than
expected. It cannot be predicted but over-use of the arm can contribute. If the
bone fails to unite (non-union), the surgery has to be repeated.
     e.. Stiffness About 5% (1 in 20) of people are sensitive to hand surgery and
their hand may become swollen, painful and stiff after any operation
(algodystrophy). This problem cannot be predicted but can be contributed to
under-use of the arm and failure to do the exercises. It is treated with
physiotherapy.
   Operative series

   SAUVE-KAPANDJI PROCEDURE

   It is extremely difficult to stabilise the DRUJ if the ligaments have been
damaged. Furthermore, if the joint itself is damaged, simple stabilisation will
not solve the problem. The combination of problems is dealt with by the
Sauve-Kapandji procedure. The operation involves a cut on the wrist to allow
access to the bone. 10-12mm of the ulnar are removed. The bone ends are then
held together by a screw. The operation creates a new joint, further down the
ulna.




   This is not a "normal" joint and probably is never going to be as good as the
DRUJ before it was injured. The operation has two effects.

     a.. Stabilisation It prevents abnormal movement at the DRUJ
     b.. Unloading The ulnar bone can be shortened to allow more force to be
transmitted across the radius (which is not damaged) rather than across a
damaged TFCC.
   The operation is performed under general anaesthetic. You will stay in
hospital for one night after your operation.
   Hand elevation is important to prevent swelling and stiffness of the fingers.
Your hand will be placed in a bulky dressing which includes a plaster to protect
the operation. Movement of the hand should be continued.

   The day after the operation, your plaster will be changed to a lighter splint.
At this stage, you can remove your splint in the day. It is permitted to perform
light activities and your exercises. The splint should be worn at night or in
situations where the operation site may be knocked (shopping, in the street,
children running about). Heavy unprotected twisting movements should be avoided
(steering wheel, screw-driver, bottle opener) as this puts great stress across
the joints.

   Lessening tenderness indicates good progress. You will need to wear the splint
less and you will be able to do more. You will be advised about this but common
sense will guide you (i.e. if it hurts, stop doing it!). It may be 12 - 16 weeks
before you can consider a return to heavy activities.

   You must remember that the operation does not cure the problem. It is only
hoped to reduce the pain but it will not abolish your symptoms. There may be
other problems in the wrist joint which also cause pain. These will have been
discussed before surgery.

   Complications

     a.. Scar You will have a scar on the side of the wrist. It will be somewhat
firm to touch and tender for 6-8 weeks. This can be helped by massaging it
firmly with the moisturizing cream.
     b.. Infection This can occur after any operation and would be treated by
antibiotics.
     c.. Nerve damage A small nerve running in the region can occasionally be
damaged during the surgery and either cause numbness on the back of the hand or
form a painful spot in the scar (neuroma). The latter complication may require a
further operation to correct it.
     d.. Clicking Up to 20% of patients experience some clicking during
pro-supination. This is usually just a nuisance but some patients find it
painful. This complication is difficult to solve and can require further
surgery.
     e.. Stiffness About 5% (1 in 20) of people are sensitive to hand surgery and
their hand may become swollen, painful and stiff after any operation
(algodystrophy). This problem cannot be predicted but can be contributed to
under-use of the arm and failure to do the exercises. It is treated with
physiotherapy.
   Operative series



------------------------------------------------------------------------------



   This information relates solely to my clinical practice. The views and
management of other surgeons may differ.



------------------------------------------------------------------------------



   H.J.C.R. Belcher, MS, FRCS (Plast), Consultant Hand & Plastic Surgeon


   Queen Victoria Hospital, Holtye Rd, East Grinstead, SUSSEX RH19 3DZ, UK



------------------------------------------------------------------------------
         Hand Surgery Home-Page Information sheets
         Operative series index British Society for Surgery of the Hand


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

Hi guys.

well one day after I send a moderator warning we get a spam. But this low life
spammer didn't get through due to the fact that I had them already moderated,
(emails moderated).
the offending now non member is ignatia-kirkland330@... so if
any one receives emails from this low life then send them back with heaps of
abuse. like I do. and also report the person for spam.

tke care all

Col


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

KienbockDisease_Australia     A Moderator Message

GROUP OWNER/HEAD MODERATOR WARNING

Notice to All Members: GROUP OWNER/HEAD MODERATOR WARNING

Lately we have also had a recent influx of Unwanted Members (such as Spammers
etc), As soon as I am aware of this occurrence I immediately Ban that person,
and report the offending email address for illegal spamming to the correct
authorities.  Spamming is Illegal in Australia.

It is recommended that you also block these offending people from your email
box, I am sorry for these uncontrollable inconvenience's.

This is a Open Group that anyone may join. We do not Moderate your Membership
(we do not say who and who cannot join, as other groups do), but at the same
time we do not want unwanted people using this group as an advertising ploy for
their own personal financial gain or ploys.

We respect that most people if not all people who join this group, would be with
the intent of looking for Support and Finding out more about Kienbock's Disease.
Whether they be a KD Sufferer, Family or Friend, or even for Research, we do not
Moderate your Membership, but spamming is not on.

We are here to Share and Help Others with their Ordeals with 'Kienbock's
Disease', not for your Own Personal Financial Gains or Ploys.

Therefore any person spamming this group with non KD material will be banned
with no questions asked.

People wishing to comment on this Moderator Warning should email me directly at
KienbockDisease@... or
KienbockDisease_Australia-owner@yahoogroups.com


Col Pickering
KienbockDisease@...
Group Owner/Head Moderator
Kienbock Disease Australia
Support and Information Group

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

hi Gwen.

This person was removed and banned from the group as soon as they posted
there message,

  Also can I ask all members if they reply back to these idiots, that they
remove any links in the spammers mail, don't give them satisfaction of
readvertising.

Obviously these people really need to get a life

take care

Col



----- Original Message -----
From: "gwen girod" <gwengperko@...>
To: <KienbockDisease_Australia@yahoogroups.com>
Sent: Monday, April 03, 2006 9:02 AM
Subject: Fwd: [Kienbock Disease Australia] Looking for a better SEX partner!


>
> Dear Col,
>  Thouhght you might want to see this and maybe take care of it.  A
> disgrace how people use our website for their own little pleasures or
> whatever.
>  Thanks,
>  gwen
> maturewoman4745 <maturewoman4745@...> wrote:
>  To: KienbockDisease_Australia@yahoogroups.com
> From: "maturewoman4745" <maturewoman4745@...>
> Date: Sat, 01 Apr 2006 03:31:14 -0000
> Subject: [Kienbock Disease Australia] Looking for a better SEX partner!
>
> 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.
> HAVE A PAIN FREE DAY
>
>
>
>
> ---------------------------------
>  YAHOO! GROUPS LINKS
>
>
>    Visit your group "KienbockDisease_Australia" on the web.
>
>    To unsubscribe from this group, send an email to:
> KienbockDisease_Australia-unsubscribe@yahoogroups.com
>
>    Your use of Yahoo! Groups is subject to the Yahoo! Terms of Service.
>
>
> ---------------------------------
>
>
>
>
>
>  gwen
>
>
>
>
>
>
>
>
>
> ---------------------------------
> New Yahoo! Messenger with Voice. Call regular phones from your PC and save
> big.
>
> [Non-text portions of this message have been removed]
>
>
>
> 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.
> HAVE A PAIN FREE DAY
>
> Yahoo! Groups Links
>
>
>
>
>
>
>

Why would a normal man or woman want to check our your filthy website.  Get off
our website and stay off.  We don't want your kind of trash on it.'
   gwen

maturewoman4745 <maturewoman4745@...> wrote:
   I'm a hot single, I'm looking for a better SEX partner! Check my live
webcams and hot SEXY photos here:
http://findsexysingle.com/sex/hotcam.htm





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.
HAVE A PAIN FREE DAY




---------------------------------
   YAHOO! GROUPS LINKS


     Visit your group "KienbockDisease_Australia" on the web.

     To unsubscribe from this group, send an email to:
  KienbockDisease_Australia-unsubscribe@yahoogroups.com

     Your use of Yahoo! Groups is subject to the Yahoo! Terms of Service.


---------------------------------





   gwen









---------------------------------
New Yahoo! Messenger with Voice. Call regular phones from your PC and save big.

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

Dear Col,
   Thouhght you might want to see this and maybe take care of it.  A disgrace how
people use our website for their own little pleasures or whatever.
   Thanks,
   gwen
maturewoman4745 <maturewoman4745@...> wrote:
   To: KienbockDisease_Australia@yahoogroups.com
From: "maturewoman4745" <maturewoman4745@...>
Date: Sat, 01 Apr 2006 03:31:14 -0000
Subject: [Kienbock Disease Australia] Looking for a better SEX partner!

I'm a hot single, I'm looking for a better SEX partner! Check my live
webcams and hot SEXY photos here:
http://findsexysingle.com/sex/hotcam.htm





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.
HAVE A PAIN FREE DAY




---------------------------------
   YAHOO! GROUPS LINKS


     Visit your group "KienbockDisease_Australia" on the web.

     To unsubscribe from this group, send an email to:
  KienbockDisease_Australia-unsubscribe@yahoogroups.com

     Your use of Yahoo! Groups is subject to the Yahoo! Terms of Service.


---------------------------------





   gwen









---------------------------------
New Yahoo! Messenger with Voice. Call regular phones from your PC and save big.

[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.

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"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'

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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

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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.

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