wikiHow to Detect Symptoms of Avascular Necrosis

Three Parts:Recognizing AVNMinimizing AVN Pain at HomeTreating AVN Medically

Avascular necrosis is a condition in which blood supply to the bone is lost leading to bone cell death, collapse, bone destruction, and may even lead to eventual joint dysfunction. The hip is the most common site of avascular necrosis, though it can attack any bone or joint. The only real symptom is pain. While avascular necrosis doesn't seem threatening from the outset, if left untreated, it can become very serious – in fact, at the first sign of bone pain, you should visit your doctor.[1] However, starting with Step 1 below, you can detect the symptoms and put a stop to it before serious treatment is necessary.

Part 1
Recognizing AVN

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    Know that stabbing, shooting pain is the only major symptom. As the bone or joint is breaking down, it will manifest as sharp pains that are often described as stabbing, shooting, tearing or piercing. If you have AVN in your hip, this pain will be more focused in the groin, thigh and buttocks.
    • It is easy to detect the symptoms of having AVN as it has only one: pain. Unfortunately, AVN is painless at first, so if you experience pain, it means that AVN is getting worse.
    • Pain is only felt in the area where AVN is present. The most common areas affected are joints in the hip, shoulder, knee, hand and foot, with the hip being most common of all.[2]
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    Know you'll feel more pain if you put weight or pressure on the bone. And as the condition progresses or gets worse, pain may occur even if you are lying down or resting. With pressure on the bone or joint, you may also experience stiffness and muscle spasms.
    • Severe pain is described as such when it interferes or limits your joint function or activity. This, unfortunately, means this joint is already collapsing or breaking down.
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    Know that the pain will only get worse if left untreated. The progression of AVN may take months to a year.[3] The pain may intensify from mild to severe if it is left untreated. There is no way to determine how often the pain will occur. The only thing you can expect is more pain more often if you continue to do things involving the damaged area.
    • Stiffness and muscle spasms, too, will likely occur more often as the muscles from the damaged area lose support from the bones. The veins in the muscles, for the record, are highly affected as well because of decreased blood flow.[4]
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    Consider factors that increase the risk of AVN. AVN can happen to anyone, but it is most common in men between the ages of 30 and 60. Recognizing how these factors come into play in your life can help you determine the likelihood of AVN affecting you. Here are the common risk factors that can lead to this condition:
    • Alcohol drinking. Too much alcohol in the body can develop fat in the passage way of blood. This fat interrupts or blocks blood flow, including in the bones, which is the number one cause of avascular necrosis.[5]
    • Corticosteroid use. Long-term use of this drug can increase the risk of having avascular necrosis. It is said that steroids interfere with the body’s ability to break down fats which blocks or narrows the passage way of blood in the bones causing blocked blood flow in the bones.
    • Other medical conditions. There are medical conditions that increase the risk of having AVN. Usually these medical conditions have indirect factors, but it is again associated with the use of corticosteroids. These medical conditions are HIV, lupus, diabetes, sickle cell anemia, Gaucher's disease, blood clots and artery damage.
    • Medical procedures. There are medical procedures that can contribute to have the risk of having AVN. Radiation for cancer patients, Dialysis and Organ transplant specifically Kidney transplant are examples of this procedures. These medical procedures involve use of Corticosteroids in the onset of the procedures. Remember, Corticosteroid use is a major risk factor of having AVN.
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    Talk to your doctor as soon as you expect you may have AVN. Pain occurs at rest if the condition is left without management, causing more and more bone destruction. Thus, take action as soon as possible to prevent the progression of this disease. Even if AVN isn't the culprit, it's still wise to talk to your doctor. Arthritis and osteoporosis, to name two similar, common examples, are also conditions that deserve treatment.
    • Often mild symptoms – pain that is simply an achy discomfort – are ignored and simply dealt with. Unfortunately, AVN isn't something that will go away on its own and requires treatment as soon as possible.
    • Stiffness and restriction of joint movement (if there is a joint affected) happen due to a lack of nutrition to parts of the joint surface, which results in osteoarthritis. What starts out as AVN can progress to more complicated issues – yet another reason to consult your doctor.
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    Know what avascular necrosis is and how it's diagnosed. Avascular necrosis (or AVN) is a disease involving the loss of blood supply in the bones that causes death of bone tissues. This leads to breaks in the bone and if left untreated, bones will collapse. AVN is also known as osteonecrosis, aseptic necrosis and ischemic bone necrosis.[6]
    • X-rays can help but usually show changes only in the late stages. Bone scan and Magnetic Resonance Imaging (MRI) are also procedures that help to diagnose AVN.

Part 2
Minimizing AVN Pain at Home

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    Use ice. You can decrease pain and inflammation by using ice packs on the affected bone and/or joint. Take an ice pack, wrap it in a cloth or resealable plastic bag, and keep it on the area for 15-20 minutes. Do this every 2 to 3 hours. Any longer and you may numb the area and risk tissue damage.
    • Massaging the surrounding muscles may help in relieving pain, too. With your ice pack on the area, take your other hand and gently rub the surrounding tissues to keep blood flowing.
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    Carefully exercise the area. The aim of exercise in the treatment of AVN is to prevent joint stiffness, relieve pain, and promote healing. It increases blood supply to the affected area, which helps the joint or bone receive nutrients. This aids in the healing process, too. Talk your doctor or physical therapist about what exercises are appropriate for your condition.
    • Although it is hard to do physical activities if you have AVN, there are proper exercises for the disease that can be done with the help of a therapist. Each case of AVN is slightly different and requires slightly different exercises to improve. These strengthening exercises should be determined by a doctor.
    • Exercise the joint in all directions to increase your range of movement. This increase in nutrients to all joint surfaces prevents osteoarthritis, which also limits joint movement.
    • Of course, weight bearing exercises are not recommended as they can worsen the situation. Exercises should include stretching, brisk walking, and toning exercises.[7]
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    Rest. AVN causes undue stress in your bones. Rest is needed so that your bones can relax, preventing an increase in bone damage. Restrict work and activities that require pressure, movement and weight on the affected joints.
    • This is important whether or not your are getting medical treatment. In the case of hip or knee AVN, using crutches can support or assist your movement so you can still move around – but healthily.
    • The balance between exercise and rest needs to delicately maintained. Safe exercises need to be performed to keep blood flowing in the damaged area; it's unsafe movement, like lifting heavy objects for example, that needs to be avoided.
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    Avoid putting the bone/joint to work. When you can, stay off the joint. Use crutches or a walking aid, like a cane, if the affected area is your hip or ankle. Talk to your doctor to determine the appropriate amount of time to use an aid. You will have to exercise the area some to keep it flexible.
    • Decreasing the weight the bone/joint has to bear can delay or prevent surgery entirely when done early enough in the progression of the disease. Staying off it appropriately can quicken the natural healing of the joint.

Part 3
Treating AVN Medically

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    Try nonsteroidal anti-inflammatory drugs or NSAIDs. These drugs relieve pain and inflammation. Many are available over-the-counter. However, they only treat the symptoms of AVN and not the root of the issue. Here are some common examples:
    • Ibuprofen. 200 to 400mg should be taken every 4 to 6 hours
    • Naproxen. 200 to 220mg taken twice per day
    • Ketoprofen. 12.5mg taken every 4 to 6 hours
    • Aspirin. 325mg taken every 3 hours or 500mg every 6 hours
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    Consider taking blood thinners. Blocks in the passage way of the blood in the bones can form blood clots. Blood thinners such as warfarin can prevent clots in vessels to aid in the supply of blood in your bone. The recommended dosage of warfarin is usually 2-5mg daily.[8]
    • Cholesterol drugs work similarly to blood thinners, reducing the amount of fat in the blood. As fats are the one causing the blockage of blood flow in the bones resulting in AVN, these drugs can really be a great help. A common example is rosuvastatin, usually recommended at 5mg daily.
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    Talk to your doctor about osteoporosis drugs. Bones that are injured or broken can cure themselves on their own time. This is why a child with a broken arm, for example, isn't a huge concern. But if bone damage is associated with AVN, the progress of bone damage is so fast that bones fail to repair on their own. Osteoporosis drugs can help your bones repair themselves more quickly, slowing the effects of AVN.[9]
    • Bisphosphonates drugs, the major class of osteoporosis drugs, like alendronate, are usually taken at 5- 10mg daily.
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    Avoid alcohol and certain medications. Avoid alcohol to decrease the risk of future avascular necrosis and/or to improve your prognosis if AVN is currently taking toll on one of your bones and/or joints.
    • Avoid steroids if possible, too. Some diseases need steroid treatment at high doses. If you're currently treating another illness with steroids, talk to your doctor to find an alternate medical route to take.
    • Any treatment you undergo may not be affective if you are still taking steroids or drinking alcohol.[10]
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    Consider surgery. If bones collapse entirely or are broken down already, surgery or entire replacement of the joint is recommended. It will be replaced with a metal or plastic bone/joint.[11][12] There are three surgeries to consider:[13]
    • Core decompression. These involve removing the inner layer of the bone. The space created stimulates production of new bone tissues and blood vessels. It reduces pain as well.
    • Bone transplant. A part of a healthy bone called a graft is taken from a different part of your body that is connected to the area affected by AVN. This strengthens the damaged area and allows new cells to grow.
    • Bone reshaping. This is also called osteotomy. This procedure removes a part of the weight bearing joint, whether above or below, shifting the weight from a different part near the damaged area. This delays joint replacement.


  • Treatment for AVN is prevents the bone form totally breaking down, ensuring and improving the function of the joints, and relieving pain. Appropriate treatment depends on the age of the patient, if it is in its early or late stage, the location and if the affected area is big or small.

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