General Guideline Principles for Kienböck Disease

for workers compensation patients

The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Kienböck Disease.

These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.

The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.

Kienböck Disease of Hand, Wrist and Forearm Injuries

The lunate undergoes alterations in Kienböck disease, which eventually cause the lunate bone to collapse and cause severe pain and incapacity. Kienböck disease patients frequently experience chronic discomfort

Diagnostic Studies of Hand, Wrist and Forearm Injuries

  1. Diagnostic Studies of Hand, Wrist and Forearm Injuries X-Rays is recommended the detection of Kienböck disease

    Reason for Recommendation: X-rays are typically taken of both hands and are utilised to confirm the diagnosis.


  2. CT

    CT is recommended when x rays are inconclusive or negative and MRI is not recommended in order to identify Kienböck illness.

    Rationale for Recommendation – When x-rays are inconclusive or negative and MRI is not an option, certain patients may benefit from the use of CT to aid in diagnosis and therapy.


  3. MRI

    MRI is recommended when x rays are unhelpful or confusing, to identify Kienböck disease.

    Rationale for Recommendation- MRIs are advised because they help in diagnosis and management.


  4. Screening for Systemic Disorders

    Screening for Systemic Disorders is recommended for patients with Kienböck disease.

    Rationale for Recommendation – It is believed that a number of diseases predispose people to Kienböck illness. The threshold for evaluating rheumatological investigations, drunkenness, and systemic metabolic conditions (such as diabetes, glucose intolerance), should be low, especially when possibly adjustable hazards may theoretically reduce the rate of advancement.

Medications of Hand, Wrist and Forearm Injuries

Ibuprofen, naproxen, or other NSAIDs from an earlier generation are suggested as first-line treatments for the majority of patients. For patients who are not candidates for NSAIDs, acetaminophen (or the analogue paracetamol) may be a viable alternative, even if the majority of research indicates it is just marginally less effective than NSAIDs.

There is proof that NSAIDs are less dangerous and just as effective in treating pain as opioids, such as tramadol.

  1. Non-Steroidal Anti-inflammatory Drugs (NSAIDs) for Treatment of Acute, Subacute, or Chronic Kienböck disease

    Non-Steroidal Anti-inflammatory Drugs (NSAIDs) for Treatment of Acute, Subacute, or Chronic Kienböck disease is recommended to treat Kienböck Disease, whether it be chronic, subacute, or acute.

    Indications – Treatment with NSAIDs is advised for Kienböck illness that is acute, subacute, or chronic. First, try over-the-counter (OTC) medications to see whether they work.

    Frequency/Duration: Many Patients may find it reasonable to use as needed.

    Indications for Discontinuation: Symptoms go away, the medication is ineffective, or negative side effects arise that require stopping the medication.


  2. NSAIDs for Patients at High Risk of Gastrointestinal Bleeding

    NSAIDs for Patients at High Risk of Gastrointestinal Bleeding is recommended for people at high risk of gastrointestinal bleeding to take misoprostol, sucralfate, histamine Type 2 receptor antagonists, and proton pump inhibitors together.

    Indications: Cytoprotective drugs should be taken into consideration for patients with a high-risk factor profile who also have indications for NSAIDs, especially if a prolonged course of treatment is planned. Patients who have a history of gastrointestinal bleeding in the past, the elderly, diabetics, and smokers are at risk.

    Frequency/Dose/Duration: Proton pump inhibitors, misoprostol, sucralfate, H2 blockers recommended. Dose and frequency per manufacturer. There is not generally believed to be substantial differences in efficacy for prevention of gastrointestinal bleeding

    Indications for Discontinuation: Intolerance, the emergence of negative effects, or the stopping of NSAIDs.


  3. NSAIDs for Patients at Risk for Cardiovascular Adverse Effects

    The advantages and disadvantages of NSAID therapy for pain should be explored with patients who have a history of cardiovascular disease or who have several cardiovascular risk factors.


  4. NSAIDs for Patients at Risk for Cardiovascular Adverse Effects


    1. NSAIDs for Patients at Risk for Cardiovascular Adverse Effects are recommended As far as harmful cardiovascular effects go, acetaminophen or aspirin as first-line therapy seem to be the safest options. Hand, wrist, and forearm injuries reported to


    2. NSAIDs for Patients at Risk for Cardiovascular Adverse Effects are recommended If necessary, non-selective NSAIDs are recommended to COX-2-specific medications. To reduce the chance that an NSAID will negate the protective effects of low-dose aspirin in individuals receiving it for primary or secondary cardiovascular disease prevention, the NSAID should be taken at least 30 minutes after or eight hours before the daily aspirin.


  5. Acetaminophen for Treatment of Kienböck disease Pain

    Acetaminophen for Treatment of Kienböck disease Pain is recommended for the treatment of pain caused by Kienböck illness, especially in patients who have NSAID contraindications.

    Indications: All Kienböck disease patients have pain, which can be acute, subacute, chronic, or post-operative.

    Dose/Frequency: As per the manufacturer’s recommendations; can be used as required. Over four gm/day, there is evidence of liver toxicity.

    Indications for Discontinuation: Resolution of pain, adverse effects or intolerance.


  6. Topical Medications

    Topical Medications is recommended for the management of pain in a few people who have acute, subacute, or chronic Kienböck illness. includes lidocaine patches, topical creams, and ointments

    Rationale for Recommendation – TOPICAL DRUG DELIVERY (e.g., capsaicin, lidocaine, NSAIDs, salicylates, and nonsalicylates) may be an acceptable form of treatment in some patients.

    To achieve the desired benefit while avoiding potential toxicity, a topical agent should be prescribed with strict application instructions and a maximum number of applications per day. Because the long-term effects of most patients are unknown, they may be better used episodically.

    These medications could be used in patients who prefer topical treatments over oral medications. Depending on the medication agent used, localised skin reactions may occur. Prescribers should keep in mind that topical medications can cause toxic blood levels.

    Capsaicin offers a secure and efficient substitute for systemic NSAIDs, albeit local stinging or burning that usually goes away with regular use limits its use. To prevent accidental contact with eyes and mucous membranes, patients should be instructed to apply the cream with a plastic glove or cotton applicator to the afflicted region. The prolonged usage of capsaicin is not advised.

    Topical Lidocaine is only suggested when a diagnosis of neuropathic pain has been made in writing. In this case, a trial lasting no longer than four weeks may be taken into consideration, with the requirement of functional gains being documented as a requirement for further usage.

    Topical NSAIDs (for example, diclofenac gel) may reach potentially therapeutic tissue levels. Overall, the low level of systemic absorption can be advantageous, allowing these medications to be applied topically when systemic administration is generally contraindicated (such as patients with hypertension, cardiac failure, peptic ulcer disease or renal insufficiency).

    Topical Salicylates or Nonsalicylates (such as methyl salicylate) do not generally seem to be more efficient than topical NSAIDs. Especially in individuals with chronic illnesses where systemic therapy is generally contraindicated, it may be administered for a short course or as an adjuvant to systemic medication.


  7. Opioids of Kienböck Disease

    Opioids are not recommended for acute, subacute, or chronic Kienböck disease.

    Opioids are recommended for limited use (not more than seven days) for postoperative pain management as adjunctive therapy to more effective treatments.

    Indications: For post-operative pain management, a brief prescription of opioids as an adjunct to more effective treatments (particularly NSAIDs and acetaminophen) is frequently required, particularly at night.

    Frequency/Duration: As needed during the day, solely at night thereafter, and finally completely discontinued.

    Rationale for Recommendation: When NSAIDs are ineffective in relieving a patient’s pain, opioids should be used sparingly, especially at night. Opioids are advised for brief, selective usage in postoperative patients, with nighttime use being the main recommendation for achieving postoperative sleep.

Rehabilitation of Hand, Wrist and Forearm Injuries

Rehabilitation (supervised formal therapy) required as a result of a work-related injury should focus on restoring functional ability required to meet the patient’s daily and work activities and return to work, with the goal of restoring the injured worker to pre-injury status to the greatest extent possible.

Active therapy calls for the patient to put in an internal effort to finish a particular activity or assignment. The procedures known as passive therapy rely on modalities that are administered by a therapist rather than the patient exerting any effort on their side.

Passive therapies are typically seen as a way to speed up an active therapy programme and achieve concurrently objective functional gains. Over passive interventions, active initiatives should be prioritised.

As an extension of the therapy process, the patient should be advised to continue both active and passive therapies at home in order to sustain improvement levels.

To facilitate functional gains, assistive devices may be included as an adjunctive measure in the rehabilitation plan.

Therapy: Active of Kienböck Disease

Therapeutic Exercise

  1. Therapeutic Exercise

    Therapeutic Exercise – Acute Phase is not recommended during acute presentations of Kienböck disease


  2. Therapeutic Exercise – Post-Operative/Recovery

    Therapeutic Exercise – Post-Operative/Recovery is recommended for patients post-operatively.

    Rationale for Recommendation – In general, acute activity is not recommended; however, recuperation or post-operative stages may require exercise. Increased grip strength, critical pinch strength, range of motion, and the development of work skills should all be considered functional goals.

    Frequency/Dose/Duration –Total visits may be as few as two to three for patients with mild functional deficits or as many as 12 to 15 for patients with more severe deficits who have documented ongoing objective functional improvement.

    If there is evidence of functional improvement toward particular objective functional targets, more than 12 to 15 visits may be necessary when there are persistent functional deficiencies (e.g., increased grip strength, key pinch strength, range of motion, advancing ability to perform work activities).

    A home exercise regimen should be created as part of the rehabilitation strategy and carried out alongside the therapy.

2. Therapy: Passive of Kienböck Disease

Therapy: Passive

  1. Self-Application of Ice

    Self-Application of Ice is recommended to treat Kienböck disease that is acute, subacute, or chronic.


  2. Self-application of Heat

    Self-application of Heat is recommended Kienböck disease, whether acute, subacute, or chronic.

    Splints are recommended for the treatment of a subset of patients with Kienböck illness, whether it be acute, subacute, or chronic.

    Rationale for Recommendations – To determine whether splinting relieves symptoms, a trial may be helpful. Long-term use, however, raises questions about the possibility of increased wrist weakness and debility.

Surgical treatments of Kienböck Disease

Surgical treatments

Surgical treatments are recommended if not improved eight weeks after the injury or after six weeks of non-operative treatment for Kienböck disease, as a treatment option for individuals with moderate to severe impairment. The decision to perform surgery depends on the disease’s stage and the surgeon’s judgement.

What our office can do if you have Kienböck Disease

We have the experience to help you with their workers compensation injuries. We understand what you are going through and will meet your medical needs and follow the guidelines set by the New York State Workers Compensation Board.

We understand the importance of your workers compensation cases. Let us help you navigate through the maze of dealing with the workers compensation insurance company and your employer.

We understand that this is a stressful time for you and your family. If you would like to schedule an appointment, please contact us so we will do everything we can to make it as easy on you as possible.

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15:02 02 Mar 23
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21:23 25 Feb 23
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20:20 19 Feb 23
Dr Vaksha, is a great doctor very professional knows what he talking about. Treat patient with upmost respect. Thank You
Troy Spencer
16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
blanca ventura
21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
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19:01 25 Oct 22
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21:28 23 May 22
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17:39 18 May 22
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19:54 16 May 22
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00:48 13 May 22
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23:17 12 May 22
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19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
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19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
00:46 03 May 22
I have seen Dr. Kuo two times already and he's awesome along with his staff. Very friendly office and I'm glad to be a patient here.
Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
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19:01 22 Apr 22
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03:25 09 Apr 22
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Donna Anne
22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs
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14:53 03 Mar 22
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Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
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21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
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19:31 18 Nov 20
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18:17 17 Nov 20
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16:45 17 Nov 20
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04:44 17 Nov 20
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Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
Ryan Brigandi
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18


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I am fellowship trained in joint replacement surgery, metabolic bone disorders, sports medicine and trauma. I specialize in total hip and knee replacements, and I have personally written most of the content on this page.

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