Lunate Malacia
introduction
As a layperson, the term lunate malacia (composed of lunate malacia) can imagine little or nothing. If you have received the diagnosis yourself, you already know that it is a Hand disease must act, because it hurts. But what exactly is this disease, what on the hand is affected and does it pass again?
definition
The lunate malacia is one Carpal bone disease, the so-called "Moon leg“But if left untreated, the disease can lead to bone death. Several causes are responsible for the development of lunate malacia, although the exact mechanism by which the disease develops is still partly unclear. Other names for the lunate malacia are "Kienböck's disease" and aseptic Bone necrosis of the Os Lunatum.
The Lunate bone is one of the eight small carpal bones of the hand skeleton and means moonbone in German. It is in the middle of the upper row of the carpal bones and forms a Articular surface with the spoke of the forearm (radius).
The malacia of a bone or organ means Softening or dissolution. In medical jargon, the lunate malacia is also used idiopathic vascular osteonecrosis of the lunar bone called. This term contains all the important information about this disease. Idiopathic means something like of unknown origin and indicates that here is a bacterial inflammation of the bone does not matter (aseptic= without bacteria / virus involvement). Vascular has something to do with the Vascular supply of the bone to do. Osteonecrosis is the technical term for that Die (necrosis) of a bone (Osteo-). So the lunate malacia is a Self-arising, vascular-related death of the carpal bone Os lunatum.
Figure carpal bones
The eight carpal bones
Upper (proximal) row - blue
Lower (distal) row - red
- Scaphoid bone of the hand -
Scaphoid bone - Moonbone - Lunate bone
- Triangular leg - Os triquetrum
- Pea bone - Os pisiform
- Large polygonal leg
(Trapezoidal leg) - Trapezium - Small polygonal bone
(Trapezoid leg) -
Trapezoid bone - Head leg - Os capitatum
- Hook leg - Hamate bone
- Cubit - Ulna
- Spoke - radius
- Metacarpal bones - Metacarpals
- Phalanx - Ph. Proximalis
You can find an overview of all Dr-Gumpert images at: medical illustrations
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causes
The lunate malacia is caused by a decreased blood flow to the lunar bone, a small bone of the hand. This decreased blood supply then leads to a slow damage to the bonewhich over time becomes more and more unstable until it finally breaks. One can imagine the mechanism similar to a heart attack, only in the bone, which takes place very slowly, because bones have a much slower metabolism than the heart. But in the end, the bone tissue that is not supplied with blood also dies.
Where does this reduced blood flow come from and why does it occur primarily on this bone?
Since people who work with jackhammers for a long time are very often affected, it is assumed that either how vibration or the direct damage from the vibrations are disease-causing. The vibrations are suspected of causing the vessels that supply the carpal bones to contract through an unknown mechanism. This will reduce the blood supply and damage the bone. Another factor seems to be that when working with the jackhammer the hand usually overstretched is and so sufficient outflow of blood is not possible is. Another theory is that the moon bone is directly damaged by the repeated jarring causing microscopic cracks in the bone. But why exactly is the lunar bone, ie the "Os Lunatum" damaged? After all, there are eight carpal bones! The os lunatum is located in the middle of the row of carpal bones close to the trunk and is therefore exposed to particularly high loads and is therefore particularly affected by vibration. Even with a shortened ulna, i.e. one of the forearm bones, there is an increased risk of lunate malacia. A shortening of the ulna is actually not pathological and does not in itself cause any complaints, but the shear forces on the wrist are considerably higher due to the changed position of the joint, so that 70% of all patients with lunate malacia also have a shortening of the ulna.
Frequency distribution
Are affected more male patients (four times more often than women), the peak age is between 20-40 years.
complaints
Since the lunate malacia a slow process that does not arise from one day to the next, it is often difficult to identify the onset of the symptoms. Typically, however, wrist pain occurs, usually on the side of the back of the hand and in the middle. Of the Pain is usually caused by pressure and movement reinforced. In the course of the disease, the pain spreads more and more over the wrist and there is also pain when leaning on the affected hand. In the later course of the disease also come Restrictions in movement to.
Lunate Malacia or Tendonitis?
It is sometimes difficult to distinguish lunate malacia from tendonitis, especially because tendonitis is much more common than lunate malacia. How can you be sure here? In contrast to tendinitis, where the Pain most of time several points affect and also occur on the inside of the hand, the hand hurts with lunate malacia, on the other hand, especially at the beginning of the disease, strictly circumscribed on the lunar bone, i.e. central on the side of the back of the hand. Another factor is, of course, whether you carry out activities that endanger the moonbone. If, for example, you do not perform any activities with strong vibrations on your hands, this makes lunate malacia much less likely. However, further diagnostics must be carried out to be sure to rule out lunate malacia.
X-ray wrist
- Cubit (Ulna)
- Spoke (radius)
- wrist
- Stylus process (Ulna styloid process)
- Moonbone (Lunate bone)
- Scaphoid (Navicular bone)
Diagnosis
The diagnosis is often based on a combination of manual tests and imaging of the wrist.
The so-called Ballottement test of the wrist the lunar bone is shifted back and forth by the examiner towards its neighbor, the scaphoid bone. If the stability between these two carpal bones is reduced, one speaks of one positive ballottement test. Often this is Shear motion also painful for the patient as well as manual pressure directly on the lunar bone.
If you are suspected of having lunate malacia, a X-ray image of the hand be included. The X-ray image is relatively cheap and most practices have an X-ray machine so that the way and waiting times are usually short. The disadvantage, however, is that the x-ray image only shows very advanced stages of the lunate malacia, which have already significantly damaged the bone. A lunate malacia can only be confirmed with the X-ray, but never excluded.
The following are the stages that can be distinguished on an X-ray:
Stage 1: Partly are still here no changes visible. If necessary, a slight compression of the lunar bone detect. The outer contour is not interrupted.
Stage 2: There are circular bright spots visible in the X-ray and the outer edge becomes misshapen.
Stage 3: At this stage it is Moonbone already disintegrated, the wrist structure becomes unstable.
Stage 4: In addition to the crumbled moon bone and unstable wrist, a arthrosis of the wrist.
If the x-ray does not show any changes, but the clinical signs match the lunate malacia and the urgent suspicion persists, an MRI scan (MRI) of the wrist. Here is already in stage 1 the bone decay is visible.
Classification
Like much in medicine, lunate malacia is also in different stages divided, whereby the stage increases as the disease progresses. The most common is the division according to Decoulx into four stages. in the Stage 1 Changes in bone density are only detectable in the MRI. in the Stage 2 show up first Damage to the bonesome of which are already detectable in the X-ray. in the Stage 3 is the bone already beginning "crumbled " and in Stage 4 is the moon bone completely destroyed, the wrist is affected, and neighboring bones are also partially damaged.
therapy
If you have lunate malacia, it is important to know what treatment options are available. Depending on the stage of the disease, other procedures are available. Surgery may be bypassed at a very early stage, but the likelihood of doing so is low. In stage 1 and 2 you can try that wrist for a relatively long time immobilize and so to relieve. For three months either a Plaster splint or one bandage carried. Then it is checked whether the blood circulation in the moonbone has improved. If this is the case, surgery may be avoided. As a rule, however, an operation is necessary, although the type of operation differs depending on the initial situation. If the ulna, i.e. a forearm bone, is shortened, this puts a considerable strain on the moon bone, as already mentioned. Hence in this case the other forearm bone becomes the spoke, also shortened by a few millimeters in one operationto take the strain off the lunar leg. However, if the ulna and radius are already the same length and a lunate malacia develops, there is the possibility of the damaged one Remove lunar bone and through the normally not so important pea bone (another carpal bone) to replace. This operation is called Saffar operation designated. If neighboring bones are already displaced in the course of the disease, the carpal bones often have to be partially united in order to prevent a misalignment. In the worst case, when significant parts of the wrist are already affected and the moon bone is already in the process of dissolving, there is still one last resort surgical stiffening of the wristto prevent the pain. As the name suggests, however, the wrist is stiff afterwards. The fingers can still be moved freely, which means that the hand can be used to a large extent. The rotation of the hand is not impaired either, since it does not take place in the wrist. Replacement with an artificial material has been tried in the past, but no material has been able to adequately replace the bone. Most of the time, the implants shifted or broke under load, which is why no implants are used for the lunar bone these days
Occupational disease
For certain professional groups who work with tools with "primarily low frequency components“, Like jackhammers or soil compactors, and have been active in the field for at least two years, lunate malazia is recognized as an occupational disease. For normal, hand-held chisels, however, this occupational disease does not apply. In case of doubt, you should ask your doctor whether recognition as an occupational disease is conceivable, and in case of doubt or suspicion of an occupational disease, an application should be completed by the doctor.
Prophylaxis and prognosis
Avoiding this condition is difficult, especially when you are in one Risk profession is working.However, since the disease can completely heal again if diagnosed in good time, the earlier you experience wrist pain, the better your prognosis See a doctor. Then calm down and wait.
