Kienböck's disease is a rare, painful disorder of the wrist that can seriously restrict the quality of life of patients who have the disease. Although a century has passed since the pathology was identified, its etiology is still uncertain, with mechanical, traumatic, vascular, and systemic factors all being advocated. Likewise, there is no consensus regarding treatment, and no approach-either conservative or surgical-has been demonstrated to yield significantly better outcomes. Extracorporeal shock wave treatment (ESWT) has been effective in stimulating fracture healing, and it has been adopted as a therapy to restore vascular supply in those bone conditions characterized by vascular impairment. We report our experience in treating 22 patients with Kienböck's disease at various stages with high-energy shock waves. Our results indicate that ESWT has a positive effect on pain and functional impairment of the wrist, and may delay surgical treatment. Further studies are necessary to understand the full potential of this therapeutic tool.