Kienbock Disease Survey


In an effort to determine what commonalities there are (if any) among those of us with Kienbock Disease, you are invited to participate in the following survey. (A BIG Thank-You goes to Lydia for getting this survey off the ground!)


    Are you male or female?


    Age when you first noticed Kienbock symptoms?


    Current Age?


    Does any other member of your family have Kienbock Disease?

      Check all that apply.

      Grandparent
      Parent
      Child
      Brother or Sister
      Other Family Member


    Which hand is affected?


    Stage at time of diagnosis?

      Right Hand:

      Left Hand:


    Current Stage?

      Right Hand:

      Left Hand:


    Current and/or Past Treatment?

      Check all that apply.

      None
      Brace
      Casting
      Radial Shortening
      Ulnar Shortening
      Revascularization
      Bone Graft
      STT
      PRC
      Fusion
      Silicon Replacement

      Others:


    How long ago was your last surgery?


    Current Pain Level on scale of 1 to 10
          1=None, 10=Constant Unbearable Pain


    Current Occupation?


    History of wrist trauma

      Check all that apply.

      None
      Fall
      Sprain
      Break

      Other


    Other Bone and/or Muscle Problems?

      Check all that apply.

      Carpal Tunnel Symptoms
      Cerebral Palsy
      Reflex Sympathetic Dystrophy Syndrome (RSDS)
      Tendonitis
      Ulnar Loading

      Other


    Current grip strength? (1 Pound = .45 Kilogram)

      Right Hand:

      Left Hand:


    Current range of motion flexion?
          (How far can you bend you wrist down?)

      Right Hand:

      Left Hand:


    Current range of motion extension?
          (How far can you bend you wrist up?)

      Right Hand:

      Left Hand:


    Current range of motion ulnar deviation?
          (How far can you twist your wrist sideways away from you?)

      Right Hand:

      Left Hand:


    Current range of motion radial deviation?
          (How far can you twist your wrist sideways towards yourself?)

      Right Hand:

      Left Hand:


    Current weight lifting capacity? (1 Pound = .45 Kilogram)

      Right Hand:

      Left Hand:


    Where do you live?

      State, Province, or Territory:

      Country:


    Ethnic Background?

    In some cases hand disorders have been found to occur more commonly in people of certain ethnic backgrounds. For example, Dupuytren's Contracture, the hand disorder in which the fingers bend toward the palm and cannot be straightened, mostly affects white people with ancestors from Northern Europe. While we do not know of any correlation between ancestry and Kienbock we would like to gather information on ancestral background in case some correlation exists.

      African
      African American
      Asian or Pacific Islander
      Dutch
      English
      French
      German
      Irish
      Italian
      Japanese
      Middle Eastern
      Native American or Alaskan native
      Polish
      Slavic
      Swedish
      Not Listed
      Decline to Answer

    Would you like to subscribe to the Kienbock Mailing List?


    Please Enter Your Email Address (Optional):

          Example: JohnSmith@aol.com


Additional Comments?

Thank you for your participation in this survey!

Results will be posted when we have enough responses. Please check back!


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