File        : TFCC.mht
Description :

Jamie,
you are not nuts. I was in stage 4 when I got my dx. I did not have the  same
surgery you did i had PRC. and like you i stayed in pain and was treated  the
same way. I really do feel that you should not have to be in pain. Not in
this day and age, I am not saying over do meds either. I stayed on my dr. until
he did a total fusion and a denerveation.  The denerve will get rid of your
pain when it heals and you sill have all of the hot,cold poking feelings you
did  before. It is just better. Just keep asking my dr. would not have done
this if i  had not ask him to and brought it to his attention. if i can help
further let me  know.
wishing you a pain free day
Toni



**************Gas prices getting you down? Search AOL Autos for
fuel-efficient used cars.     
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[Non-text portions of this message have been removed]

Hey Sugar Lips,
Glad to hear things are going good for you. I miss talking to u. Just where
the hell have you been???? I e-mailed you every where that i  have a  address
for. Gee I have been thru surgery getting fragments out of my sinus that  was
May 29, my birthday was on  u should have renumbered  was June 1st  still and
yes another year older and better. Oh hopefully soon I will have a  knee
replacement. Oh Ronny told me to tell you that he knows why you are happier 
than a
pig in shit......hahaha
Love Ya my friend
Toni




**************Gas prices getting you down? Search AOL Autos for
fuel-efficient used cars.     
(http://autos.aol.com/used?ncid=aolaut00050000000007)


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

Hi all,

yes its me, back from not being anywhere.

well its been over three months since Lisa left me and i am now as
happy as a pig in shit.

to all my friends out there who helped me with support, thanks heaps.

i have also move, i put the house on the market today, and i am
renting a beautiful 4 bedroom house only 2 minutes from work. I have
Liam every second week so we have him 50/50.

also to all my friends out there i also have a new email address, yes
i have been cut off from my old provider, new email is
col@... , no i haven't internet at new joint yet.

Toni, my friend, i would like to thank you for taking the reigns of
the group while i have been away and hope you will still continue as i
cannot get here all the time now, sorry folks

To all the new members, a big welcome and hope to be eventually able
to have a chat to you all.

for any info you are after hopefully other members will post a reply
and you could also checkout the files and database in the group. As KD
doesn't get everyone the same and some people have different surgeries
for same stage it makes it hard to come up with the perfect diagnosis.

anyway will go before this becomes another 4 page email (you know me).

take care all and hope are all pain free

Col
Group founder

My name is Jamie.  I am 30 years old, and I have been diagnosed with Kienbock's
Disease only since the begining of May 2008.  I am currently recovering from
surgery.  All of this began at the beginning of the year with what I thought was
tendonitis.  I was treated for tendonitis of my thumb tendon with a cortisone
shot which worked wonderfully for that.  I had to return to the hand surgeon a
month later for a follow up, and while at that appointment I told him my thumb
felt great but the rest of my wrist still hurt.  Of course he basically
dismissed what I had told him and he said if it got worse to come back.  Well
two weeks later I was back in his office because of excruciating pain in my
right wrist (of course I'm right handed).  I was sitting there by myself
expecting him to tell me that I had tendonitis in my wrist when he comes in and
begins to explain that I have KD and I need an MRI and surgery.  Of course I was
completely in shock and terrified, especially when he
  began to tell me that I was going to be casted for 8-12 weeks or more after
surgery then in a splint for another month or two, then I still wouldn't be able
to use my right hand for 18-24 months.  The only thing I could say at that point
is I have two very small children 2 and 1.  He responded I hope you have alot of
help because you're gonna need it.  So Now I have had a radial shortening
procedure and radial bone graft into the lunate which occured on May 22.  I have
been to the therapist once who said I was doing great because I can turn my hand
up and down, and can open and close my fingers.  But I can't understand why I
still have so much of the same pain as I had before my surgery.  The therapist
asked if I was doing too much with my hand (like I could do absolutley nothing
with it with two small kids) and when I told her probably she smiled and said
well that's probably it.  I do have a wonderful support group of friends and
family who have been with me almost
  constantly since my surgery, but my children still want their mommyand don't
understand that I am hurt.  I guess my real problem is that even when I am doing
nothing I still hurt.  When I told the doctors office they treated me like a
druggie and said I shouldn't need pain meds anymore.  So am I crazy, am I a
sissy, is there a problem with the surgery, or do I just not get that this is
gonna be forever and I just need to suck it up and deal with it.  If there is
anyone who has any suggestions PLEASE I am open for them.


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

I HOPE YOU HAD A WONDERFUL BIRTHDAY,
AND YOU ARE SO VERY MUCH WELCOMED.
WITH A BIG HUG ALSO.
AND PAIN FREE DAY'S.

JOJO.

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

Thank you so Much my dear Toni and Joan and everyone else :x

Wishing you all the best and always pain free days


Loads of Love,

Muneera

thank  you very much.  you also have a pain free day.
Carita


To: KienbockDisease_Australia@...: Treeves321@...: Mon,
19 May 2008 20:26:35 -0400Subject: [Kienbock Disease Australia] Happy Birthday




Muneera,Hope you have a wonderful birthday Munera...and a very pain free one to
go with it.love yaToni**************Wondering what's for Dinner Tonight? Get new
twists on family favorites at AOL Food.
(http://food.aol.com/dinner-tonight?NCID=aolfod00030000000001)[Non-text portions
of this message have been removed]






_________________________________________________________________
Change the world with e-mail. Join the i’m Initiative from Microsoft.
http://im.live.com/Messenger/IM/Join/Default.aspx?source=EML_WL_ChangeWorld

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

Muneera,

Hope you have a wonderful birthday Munera...and a very pain free one to go
with it.
love ya

Toni





**************Wondering what's for Dinner Tonight? Get new twists on family
favorites at AOL Food.
(http://food.aol.com/dinner-tonight?NCID=aolfod00030000000001)


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

HAPPY BIRTHDAY MUNEERA,

HAPPY BIRTHDAY TO YOU,
HAPPY BIRTHDAY TO YOU,
HAPPY BIRTHDAY DEAR MUNEERA,
HAPPY BIRTHDAY TO YOU.
AND MANY MORE....
HOPE YOU HAVE A GREAT DAY,
AND EVERYONE IS PAIN FREE.
JOJO.

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

MEMBERSHIP DENIED

THIS IS A GROPUP FOR PEOPLE WITH KIENBOCKS DISEASE NOT FOR WEBMASTERS TO
JOIN.

COL
GROUP OWNER


>>
>> Hello,
>>
>> The following person would like to join the KienbockDisease_Australia
>> group:
>> Email address: aminuddinpk <amin786pk@...>
>>
>> Comment from user:
>> I am webmaster of www.Funzmania.com
>>
>>
>> This membership request requires your approval because the
>> KienbockDisease_Australia group is restricted, which means you must
>> approve each new member.

COL, I AM SO HAPPY FOR YOU.
I WISH NOTHING BUT THE VERY BEST FOR YOU AND YOUR SON LIAM. AND YOUR PLACE YOU
ARE GETTING IS WONDERFUL.SOMETHING LIKE THAT HERE IN CLIFTON PARK NY WOULD COST
YOU AROUND $1OOO.OO TO $1400 JUST TO RENT.

GLAD TO HAVE YOU BACK.

AND YES WHEN YOU ARE SINGLE AGAIN YOU SEEM TO HAVE THIS AURA ABOUT YOU THAT LETS
PEOPLE KNOW YOU ARE FREE AS A BIRD.
AND I FOUND YOUR LETTER TO BE GREAT.LIKE IT USED TO BE.
SO PLEASE STAY IN TOUCH AND KEEP ON WRITING.
I HOPE EVERYONE IS PAIN FREE,
JOJO.


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

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

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.

File        : TFCC.mht
Description :

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.

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.

File        : Ulna Variance.mht
Description : Ulna Variance

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.

"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

----- Original Message -----
From: Col Pickering
To: Undisclosed-Recipient:;
Sent: Wednesday, April 30, 2008 10:27 PM
Subject: Col is back and better than ever


Hi everyone

yep another mass email to all my friends

Anyway Col is back and doing good, check out his website it tells it all.
http://www.myspace.com/redbacknaphobia

Therapy is now finished and I am all good, no more anger, no more hurt, all my
emotions now ok. So what can I say. "I AM BACK".

Anyway I have let Lisa go from my heart, as I have been thinking really hard and
I now realize that there is a whole new world out there and I really do not want
Lisa to be a part of it, I don't even want to take any memories of Lisa into my
new life. Believe it or not I do not even have any feelings for her at all
anymore, that may shock some of you, but for what she has done to me and behind
my back there is no forgiveness in the world for that, so as far as I am
concerned the only connection we now have, is Liam.

Liam is doing really good (well with me), he seems happy and he tells me that he
is ok, but he did slip tonight by saying that he was upset with his mum, I asked
him why and he said because mum left us,,,, Very Deep for a kid only eight !! He
will be ok, as long as we both tell him we love him.

Anyway I am getting out there, even my social life is picking up. Actually
getting to meet a lot of woman out there now,  Even this afternoon I went into
the shopping centre and I was actually chatted up. I wonder if you become single
your body must throw out emissions to the opposite sex, because she approached
me. Now nothing like that ever happened when I was in a relationship, so all is
good. For those of you who new me before I met Lisa,,,, YEP I AM BACK, and you
thought I was a handful then,,,,, I FEEL FREE, and I like it, believe it or not.
I guess because of how it happened it was easier for me to let go, ,,, And there
will never be forgiveness,

Oh yeah. I got the house I applied for to rent, A one year old 4 bedroom, Master
bedroom unsuit, tiled dining and Kitchen, carpeted the rest, patio, Double lock
up and a shed, on a large block opposite bush. Its in Victoria Point and only 2
minutes from work. rang up last week,  they organised appointment for Monday
after work, On Tuesday I faxed them 13 pages with a cover Letter that
bullshitted on about me being a local business owner and all that shit. And this
morning I got the OK

I have taken out a 12 month lease then I will see about buying another house
then, First off they only offered me a 6 month lease but within a few hours they
upped it to 12 months, which is what I wanted. The rent is $390 a week, which is
good. I could of got a loan now to buy another house but the repayments would
have been over $650 a week. Anyway check it out
http://www.domain.com.au/Public/PropertyDetails.aspx?adid=5719117#

Liam is stoked about it, as he had the choice in the house I rented, if he
didn't like it we would not have gone for it. As he told me he still wants to
live here, as its his home. So I told him that when I rent or buy a house, that
it will be him choosing it, as it will be his home. Face it I am 40 years older
than Liam, So it means that if I buy a house in a year or 2, it will ultimately
be Liam's anyway. But in the mean time he is really happy about the house we are
going to rent. He was even saying before he went to bed that he cant wait to
move into the "new boys pad".

As soon as I am set up I will send my address (if you don't look it up) and new
phone, hopefully I should be able to move in from 12th May and get out of this
hell hole neighbourhood of Redland Bay. I hate everything about this place now
and be glad to get out, I really don't have any friends here so may as well get
away from it.

So in about 2 weeks I will be in a new house with a whole new life and starting
to do the Social Bit, I joined the Sharks Aussie Rules Club, sort of thought I
better, as my shop "Cartridge Citi" (had to get it at once in this email,, lol)
sponsors one of their senior players (one of the ruckmen). They have a few
functions so who knows who or what I could meet (so if I just wanna fuck it may
be a 'what', but if I meet someone who maybe nice, well then they are the 'who'
!!).

hey you lot are probably saying "fuck what a long email". Hey how often do I
send them,,,, be fucking grateful,,, lol

Anyway where was I

Oh yeah social bit, I don't think that I will ever get back into a relationship
for a very long time, if ever. Unfortunately my trust for women has been broken.
And I will always have the thought of deception in my mind. But that doesn't
mean I wont sleep with them, well not so much sleep... maybe just sex and then
piss off to your own home,,, lol.

Anyway all is good with me, still not up to calling anyone yet, but if anyone
does wanna chat I will have my phone on for about another 2 weeks then only be
my mobile or work (3207 6744 or victoriapoint@... ) until I get
re-hooked up, that will also mean internet as well guys, I will still have same
email address's, as I will just be doing a transfer from one house to the other.
Or you can leave a message on my website http://www.myspace.com/redbacknaphobia
,



To all my KD friends, take care and hope all are pain free.

hope to talk soon

Col

xoxo


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Thank you for the responses and hopefully the prc will help. I wish you
all well and pain free days as you say.
Brent

Chad,
Myself and Col  have had a denervation, Col in both hands. It is only  3
small cuts in your wrist area not your sholuder.You still have all the 
sensations
as hot- cold . it just makes it not hurt. The only draw back is the  nerves
can grow back over a period of time. so far so good.
Wishing you a pain free day
Toni



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