My first recollection of any problem with my wrist was in late March of 2002. It was Easter weekend and it was just feeling “wrong”. I only remember this because I was invited to go golfing and declined, saying I may have sprained my wrist. The problem was that I didn’t remember doing anything to sprain my wrist! At this point it was not painful at all, only feeling odd. I still had full range-of-motion. It was my left, non-dominant wrist.

Over the next month or two the odd feeling developed into a slight pain. This pain was only present when flexing my wrist all the way. It was still very subtle until my first “real” pain occurred while trying to push myself up out of a swimming pool. I collapsed back into the pool in pain and realized that something was seriously wrong. I made an appointment to see my doctor the following week.

My doctor examined the wrist and ordered an X-ray. It came back as “normal”, so he instructed me to wear a Velcro brace. He said that if the pain did not go away after 30 more days, to make an appointment with an orthopedic hand specialist.

Another month passed with no change so I called the hand specialist. There was a 7-week wait to see him! I eventually saw Dr. Robert Gelb (not to be confused with St. Louis's Dr. Gelberman), on Aug 22, 2002. He took another X-Ray and did not see anything abnormal. He performed an examination and had no ideas about what could be wrong. He ordered an MRI, which I had performed the following week.

I still remember the look on the MRI technician’s face as I was leaving the room. She actually said, “So you really don’t feel any pain in there?” I knew she had seen something dramatically wrong in the MRI.

At my next consultation I was informed I had Kienbock’s disease, and was in late stage 2 or early stage 3a. One look at the MRI showed a black hole where my lunate bone should be. Of course I had never heard of this. Dr. Gelb seemed very concerned, and was babbling on about arm surgery and bone fusions. Now, when he looked back at my X-Rays, it was possible to see a slightly whitened lunate bone. And it was also obvious that I was 2 or 3 millimeters ulnar-negitive. Both of these clues were missed by my doctor, and by Dr. Gelb.

This all came as quite a shock to me since I am an otherwise perfectly healthy, active, 37 year old with no history of any medical problems whatsoever. I have never even been in the hospital, except to visit others! It eventually took a week or so for the gravity of the situation to sink in. Finding the Yahoo Kienbock’s Disease Support Group, and the DarkerBlue web site, were both monumental aids in going through this process.

Up to this point I still had full range-of-motion, and mild pain only when I fully flexed my wrist. This dramatically changed one day in September 2002. My wrist swelled, stiffened, and I started to experience a gnawing pain. Eventually the bad pain would subside, but my wrist was now swollen all the time, and I had lost the majority of range-of-motion. I also lost a lot of strength in the hand, and for the first time, I was having difficulty grabbing things and playing guitar. Dr. Gelb was recommending a radial shortening procedure for me. By this time I had done a lot of research and was pressing him as to why he did not want to also perform a vascularized bone graft concurrently. In my mind, the joint leveling (radial shortening) would fix the alignment of my wrist, but until blood flow was restored to my lunate bone, I would not be “cured”. Dr. Gelb was initially open to the idea of the RS+VBG, but after consulting with colleagues, he decided that the RS-only was the best approach.

I located a second hand specialist. Dr. Reid Abrams is head of hand surgery at UCSD medical hospital. My initial intention was only to get a second opinion, but after meeting Dr. Abrams, I decided that I wanted him to perform my surgery. Partly because he was more direct - he frankly admitted that he has only treated 15 Kienbock’s patients in his 15 years of practice - and partly because he took the time to explain why he felt a RS-only was the best approach. His opinion was that the revas was still unproven, and possibly unnecessary. Coupled with an 80% success rate on the RS, that was his recommendation. He admitted that it’s not clear why the surgery works; in fact, it may be just the trauma of the surgery that stimulates the healing process in the body. He quoted studies that performed drilling of the radius and lunate bones with good success rates.

I underwent a radial wedge osteotomy on 25 October 2002. The surgery lasted 2 hours; I was given a general anesthesia. I awoke feeling sluggish, but was not in any great pain, nor was I feeling any stomach upset.

Over the next 48 hours I experienced moderate pain and discomfort. I was given a prescription for Vicodin and found that it would relieve most of the pain. By the 4th day I no longer required the Vicodin. At 2 weeks post-op, I had my surgical wrap removed and a hard cast put on. At 6 weeks post-op, the hard cast was cut off and I was given a removable splint. All the time in the cast, I did not experience any KD pain at all. My fingers were all flexing fairly well, with the thumb being the most affected. After a few days without the cast, my arm was feeling fairly “normal”, with my wrist ROM about the same as before surgery (not very much!). Occupational therapy started the following week. I started to notice a dime-sized area on my palm that had reduced sensations/tingling. I reported this to the surgeon, and he stated that there was a nerve that runs close to the incision site, and that the swelling and trauma from the surgery can put pressure on it. He said there was a good chance this would go away.

At about 6 months post-op, the dime-sized numb area on my palm had vanished. My ROM was at about 80% and still increasing, and I had no KD pain. I feel the plate under my skin and it does feel “odd” at times, but never painful at all.

Now at 8 months post-op, I have recovered about 90% of my ROM. I am able to play guitar and perform almost all the things I used to do - with the exception of palm-down push-ups. Some days go by and I don’t even think about my wrist at all. My scar is visible, but not too bad. People do ask me about it occasionally.

The lower X-ray was taken at 2 weeks after my radial wedge osteotomy. The titanium plate and screws are easily visible. Note the osteotomy site has not yet healed, the ulnar variance has been decreased, and the radius bonehead is no longer compressing the lunate.

I hope this information is helpful to you in some way. Feel free to email me at fkokaska@yahoo.com if you would like any more detailed information.

Fred Kokaska San Diego, California June 11, 2003