Hand Conditions

Nerve / Tendon:
Carpal Tunnel Syndrome
Focal Dystonia Syndrome
Guyon's Canal Syndrome
Hypothenar Hammer Syndrome
Trigger Finger/Tenosynovitis

Bone / Joint:
Arthritis of the Hand
Arthritis of the Thumb (Basilar Joint)
Dupuytren's Disease
Navicular Avascular Necrosis (and Kienböck's disease)


Navicular Avascular Necrosis (and Kienböck's disease)

Navicular Avascular Necrosis is the result of an insufficient flow of blood to the bone. This can happen to a carpal bone as a result of a trauma that disturbs the blood supply to the bone. It has also been associated with repetitive motion trauma.

Among some of the conditions associated with Navicular Avascular Necrosis include: Kienbock's disease (Lunate Avascular Necrosis), Preiser's Disease and Carpal Avascular Necrosis - each resulting from trauma to a different area of the carpal, though all accompanied by similar symptoms. Those suffering from the condition generally have a history of a single major wrist injury, or multiple minor occupational injuries. They suffer from chronic wrist pain, tenderness and swelling - and experience limited range of motion.

Kienbock's disease
When the affected carpal bone is the lunate, patients are diagnosed with Kienbock's disease or Lunate avascular necrosis - with pain and tenderness experienced in the middle finger. This is a rare condition, which is seen in patients from 20 to 40 years of age with a history of engaging in manual labor. Often there is a history of trauma.

Carpal Avascular Necrosis
Carpal Avascular Necrosis is generally associated with scaphoid fractures and can often go undetected until more serious problems occur. This happens when a patient assumes that an injury is a minor sprain that can heal on its own and fails to seek proper medical attention.

Proper care of scaphoid fractures is particularly important because it has a vulnerable blood supply. This blood supply enters from the top of the bone, though most fractures occur in the middle or lower portion of the bone - potentially cutting off the supply. When a scaphoid bone breaks and loses connection with its blood supply, avascular necrosis is the result. If left untreated, it may cause the bone to crumble and the wrist joint to be destroyed.

Diagnosis and Treatment
While X-rays can often time times identify areas of vulnerability, ongoing pain in certain fingers will further indicate possible navicular avascular necrosis. X-rays in advanced stages will show changing bone shape and possibly bone fragmentation and collapse depending on the severity and stage of the condition.

Intermittent immobilization for several months may be indicated for those patients suffering from carpal avascular necrosis in the early stages, in order to allow for reconstitution of normal bone architecture. And a series of range of motion exercises may also be established.

In more advanced cases, surgery may be indicated in order to address bone fragments and collapse.