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Onset ~ I awoke one morning in 1977 and noticed my left (non-dominant) wrist felt stiff, as if it was "locked" in place. I tried bending it to get it moving, and heard a "pop" in the wrist. At this time, I thought nothing of it. As days passed I realized I felt this stiffness every morning and needed to bend my wrist in the same way, always hearing the same "pop". After at least a few months, my wrist began to feel stiff and sore all day with increasingly diminished range-of-motion. I was 21 years old with no prior history of any injury to my wrist.
Diagnosis ~ In January, 1978 I visited a local orthopedic surgeon who took x-rays of my wrist and other major joints. He told me I had degenerative arthritis, though he seemed uncertain and somewhat bewildered. He put a plaster cast on my left forearm to immobilize the wrist. This decreased the soreness, but when the cast was removed in March (1978) my wrist felt sore again. The doctor continued researching other possibilities and finally announced a new diagnosis: Kienbock's Disease of my left lunate. Subsequently, on the advice of others, I took my x-rays to the Hand Clinic at UCLA Hospital & Clinics (as it was known at that time) for further evaluation. By now my wrist had very poor range-of-motion and quite a bit of pain, and I had very little strength in my grip. The orthopedic surgeons at the UCLA Hand Clinic confirmed the diagnosis of Kienbock's Disease. They showed me the area where the lunate had decayed and how the metacarpal above it had moved down ever so slightly. They recommended the best treatment available at that time: Replacement of the lunate bone with a silastic (silicon) implant. They told me my wrist would never be "normal" again but the surgery would restore some of the mobility and strength. Without treatment, the lunate would continue to decay, fall apart, and the surrounding bones would collapse to fill in the ever-increasing gap, resulting in more pain, stiffness and immobility. With little hesitation, I agreed to surgery. (X-rays of my right wrist showed early signs of Kienbock's Disease but I was told it may never progress past that point.)
Surgery ~ On March 28, 1978, my left lunate was replaced with a silastic lunate implant, leaving a fine, crescent-shaped scar on the top of my wrist. Four days later I went home with a large, rather cumbersome cast which was later replaced with a removable wrist brace. The brace protected my wrist while it healed from surgery.
Life goes on! ~ Gradually, the post-surgical pain and stiffness subsided and I began noticing that I had better range-of-motion -- and less pain -- than I had before surgery! At first I had occasional throbbing pains which lasted about a second, a few times a day. Eventually, these pains decreased in frequency and I slowly regained most of the use of my wrist. Range-of-motion has never returned to 100% normal (they told me it never would) but it is very close to normal. I am able to do anything I want to do, though my grip is still a little weak and my wrist seems to want to "go out" if I lift something very heavy in an awkward way, such as pouring liquid from a large pitcher. However, this is minor and I have learned to favor my wrist and live with its limitations. I just don't do those things it is unable to do -- which are very few in number -- or I use my other (dominant) hand to do them (such as pouring liquid from a large pitcher). In all, I believe the surgery restored my wrist to a near-normal state with very few problems through the years. Until very recently, I rarely gave it a thought any more.
New Concerns ~ In 2000, I suddenly awoke in the middle of the night with incredible, excruciating pain in my left wrist, as if my hand was being torn off my arm. (Somehow, I was able to notice that my wrist was in a normal, non-bent position and was free from any surrounding pressure.) I sat up and held my wrist, thinking my husband would need to take me to the emergency room. After about a minute or two, the pain completely subsided. This occured again at least once about a year later, and since then I've had occasional severe pains that last a few moments; all occur when I am at rest. The lunate implant is now more than 24 years old, and I have been told they don't last a lifetime -- in fact, it is very unusual for them to last this long. I've also been told there is no suitable replacement available at this time. I began to wonder what would happen to my left wrist if (or when) my lunate implant breaks down or is damaged in some way. I decided it was time for a new, up-to-date exam by a hand surgeon experienced in treating Kienbock's Disease.
Latest news ~
In September 2002, I visited an orthopedic hand surgeon at USC. I took my original x-rays and patient discharge report for his information. He ordered new x-rays and compared them to the original ones. He said the x-rays show NO problems with the lunate implant. He pointed out slight but insignificant changes in some of the surrounding bones, and said this could be what caused the recent occurances of intense pain. He was astonished (literally; he shook his head and smiled in amazement during most of the visit) about the good range-of-motion (which he described as "normal") and strength in my wrist, especially considering the implant was by now 24 years old. He also said there was NO sign of synovitis (a common complication of silicon lunate implants) -- another remarkable finding after 24 years! He said that if I lose the implant from disease or injury, the current surgical option (at that time) is to remove the implant and fuse the surrounding bones, probably resulting in a 50% loss of function in my wrist. He requested to follow my case on a yearly basis to check the condition of my wrist and track my progress. He agreed with the initial finding of Stage I Kienbock's Disease in my right wrist (the same stage as 24 years ago). He gave me a new brace that I am to wear on my left wrist for protection while doing certain activities which could damage the implant. I left his office feeling elated -- and realizing how blessed I am to have had such an amazingly successful surgery with very few complications or residual problems through the years.
In September 2004 I returned to the hand surgeon at USC for the yearly follow-up visit he requested in 2002. Though I had skipped a year and returned after two years instead, the x-rays still did not reveal any changes and the doctor continued to describe himself as "astounded" over the good condition of my wrist and the implant within.
In early 2006 I began to notice a new type of pain in my left wrist, occuring even while it is at rest. This pain seems to begin in the area of the implant itself and then quickly radiates up the hand (along the metacarpal bones) and then stops just below the nuckles. It occurs at least a few times a week, almost always more than once each time. Until now (with the exception of the intensely painful event in 2000), the pain was localized to the area of the implant only and did not radiate outward. In a few of these instances, the pain continued for several minutes. If this continues, I will mention it to the doctor at my next visit in September. The implant is now 28 years old.
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