Kienböck's Disease

KIENBÖCK'S DISEASE (Kienböck, German Lunaknochenmalacie), a disease of the lunate bone of the wrist; described by the author in 1910. It occurs chiefly in persons engaged in manual labor. The etiology has not yet been definitively clarified: it is suggested that prolonged stress on a constitutionally weak bone plays a role, as well as trauma, which in this case acts as a trigger for the disease. In its pathogenesis, Kienböck's disease is a complete analogue of the so-called Osgood-Schlatter disease (see). Pathohistological examination of the affected bone reveals aseptic necrosis of the spongy bone tissue and bone marrow of the lunate bone with its simultaneous deformation or fracture. By some authors, the pathohistological picture is interpreted as the result of a primary fracture, by others as a bone disease leading to fracture. Clinically, Kienböck's disease is characterized by pain in the wrist joint area, increasing with active and passive movements, as well as with tension in the hand, lifting weights, pulling on the hand, and tapping on the ends of extended fingers. Objectively, swelling is observed in the area of the dorsum of the joint, atrophy of the limb muscles sets in early, strength decreases, and sometimes crepitation appears. The X-ray picture varies depending on the stage of the disease: in the initial period, changes are barely noticeable; later, characteristic changes in the structure of the bone and its shape are already detected. For the most part, the disease develops imperceptibly, but cases with an acute onset have been described, characterized by irritation in the joint lasting up to several weeks; then a period of relatively good health sets in—from several days to several months—after which the disease passes into a chronic stage. Diagnosis can be made chiefly on the basis of X-ray data; in the acute period, diagnosis is difficult due to the absence of changes on the radiogram, which is why the disease is initially difficult to distinguish from a joint sprain, bruise, etc. Prognosis is in most cases serious with regard to working capacity. Mostly, one has to recommend a transition to lighter work. Treatment: in acute cases, rest, cold to the joint area, and the use of a splint with some traction in fresh cases are necessary. In the chronic course, conservative methods (heat, massage, quartz lamp) are preferred. Surgical treatment rarely yields favorable results. Prophylaxis consists of frequent short breaks during work for persons engaged in strenuous manual labor. At the first appearance of symptoms of the disease, it is necessary to immediately stop work for a time.

L. Lepilina-Brusilovskaya. KINDERBALSAM, children's balm, lifting drops, Spiritus aromaticus, Balsamum embryonum, a favorite folk remedy that was also significantly widespread in Russia, especially in rural practice. Pharmacopoeias of various countries gave various formulas for the manufacture of Kinderbalsam. The composition of Kinderbalsam according to the VI Russian Pharmacopoeia (1910) is as follows: essential oils—nutmeg 10.0, lavender 10.0, lemon 3.0, clove 3.0, dill 3.0, spearmint 3.0, cinnamon 3.0, melissa 1.0, 90% wine alcohol 1,800.0, and 70% wine alcohol 5,000.0. In folk medicine, Kinderbalsam was used at 30-40-60 drops per dose, most often in women's practice during pregnancy, after childbirth, and generally for abdominal pain, after heavy lifting, etc. Pharmacologically, if Kinderbalsam could act at all, it was only as a mild carminative agent thanks to its essential oils.