Rehabilitation in Kienböck Disease: A Narrative Review of Current Concepts

Kienböck disease, osteonecrosis of the lunate of uncertain aetiology, presents with progressive pain, stiffness, and grip loss in dominant-hand-using adults during their most productive working years, yet its rehabilitation literature has lagged behind its surgical counterpart. This narrative review synthesises current rehabilitation evidence across conservative and post-operative pathways, mapping recommendations to disease stage and to surgical procedure. Following SANRA-aligned methods with selected PRISMA 2020 transparency elements, we appraise immobilisation and orthotic management, dart-throwing-motion-plane mobilisation, sensorimotor retraining, oedema and pain control, psychosocial screening, and procedure-specific protocols that span joint-levelling osteotomy, vascularised bone grafting (including medial femoral trochlea flap), limited intercarpal arthrodeses, proximal row carpectomy, wrist denervation, and salvage arthrodesis or arthroplasty. Patient-reported, performance-based, and occupational outcome instruments are reviewed, with explicit declaration that no Kienböck-validated MCIDs exist. We also set out an integrative reference frame that cross-walks osseous, articular, and tissue-healing axes, offered as clinical orientation rather than as a validated algorithm. The most pressing evidence gaps (Kienböck-specific functional movement screens, sustained return-to-work data, and procedure-specific rehabilitation cohorts) are translated into four registered, powered, COMET-aligned trial proposals.