Avascular Necrosis (Shoulder)
A loss of blood supply to the shoulder bone that can lead to joint collapse and severe pain
Avascular necrosis (AVN) of the shoulder, also known as osteonecrosis, is a condition in which the blood supply to the humeral head (the top part of the upper arm bone) is reduced or cut off. This lack of blood flow can lead to bone tissue death, joint collapse, and arthritis, causing pain and restricted movement. Dr Ben McGrath, an orthopaedic specialist, provides expert diagnosis and treatment options to manage avascular necrosis of the shoulder, aiming to preserve joint function and minimise discomfort.
- What is Avascular Necrosis of the Shoulder?
- Common Symptoms of Avascular Necrosis
- Causes and Risk Factors for Avascular Necrosis of the Shoulder
- Diagnosis of Avascular Necrosis of the Shoulder
- Non-Surgical Treatments for Avascular Necrosis of the Shoulder
- Surgical Treatments for Avascular Necrosis of the Shoulder
- When to See Dr Ben McGrath for Shoulder Pain
- FAQs About Avascular Necrosis of the Shoulder
What is Avascular Necrosis of the Shoulder?
Avascular necrosis of the shoulder occurs when blood flow to the humeral head is disrupted, leading to the gradual breakdown of bone tissue. Over time, this can cause the bone to collapse, resulting in arthritis and significant joint damage. AVN often affects people between 30 and 60 years of age and can impact daily activities if not treated promptly.
Common Symptoms of Avascular Necrosis
Patients with avascular necrosis of the shoulder may experience:
- Shoulder Pain: Pain that initially occurs with movement but may progress to constant pain, even at rest.
- Stiffness and Limited Range of Motion: Reduced mobility, particularly during overhead movements or reaching behind the back.
- Weakness in the Shoulder: Difficulty lifting or rotating the arm due to muscle weakness.
- Grinding or Catching Sensation: A feeling of grating or catching in the joint, especially in later stages.
These symptoms often worsen over time as the condition progresses.
Causes and Risk Factors for Avascular Necrosis of the Shoulder
Avascular necrosis of the shoulder can result from:
- Trauma or Injury: Fractures or dislocations of the shoulder can damage blood vessels and lead to AVN.
- Steroid Use: Prolonged or high-dose corticosteroid use can increase the risk of AVN.
- Excessive Alcohol Consumption: Chronic alcohol intake is associated with increased risk due to its effects on bone and blood flow.
- Medical Conditions: Conditions such as sickle cell disease, lupus, and blood clotting disorders can disrupt blood supply to the bone.
- Radiation Therapy: Previous radiation treatment in the shoulder area can damage blood vessels.
Understanding these risk factors is key to managing and preventing the progression of AVN.
Diagnosis of Avascular Necrosis of the Shoulder
Dr Ben McGrath uses a comprehensive approach to diagnose AVN:
- Medical History and Physical Examination: Assessing symptoms, range of motion, and shoulder strength.
- Imaging Tests:
- X-rays: Detect bone changes in the later stages of AVN.
- MRI: Essential for early-stage diagnosis, providing detailed images of bone structure and blood flow.
- CT Scans: Used in complex cases to assess joint damage and plan surgical treatment if needed.
Accurate diagnosis is essential to determine the stage of AVN and guide treatment.
Non-Surgical Treatments for Avascular Necrosis of the Shoulder
Non-surgical management is often effective in the early stages of AVN to slow disease progression:
- Medications: NSAIDs can help manage pain and inflammation. In some cases, bone-building medications (bisphosphonates) may be recommended.
- Physiotherapy: A tailored exercise program to maintain strength, flexibility, and range of motion.
- Activity Modification: Avoiding high-impact activities to reduce stress on the shoulder joint.
- Electrical Stimulation (ES): Promotes bone growth and healing by enhancing blood flow to the affected area.
These treatments aim to alleviate symptoms and slow the progression of AVN in its early stages.
Surgical Treatments for Avascular Necrosis of the Shoulder
Surgery may be necessary for advanced stages of AVN or if non-surgical treatments are ineffective. Options include:
- Core Decompression: Removal of a small portion of the bone to relieve pressure, improve blood flow, and stimulate healing in early stages.
- Bone Graft: Transplanting healthy bone tissue to the affected area to promote bone growth and structural support.
- Shoulder Replacement (Arthroplasty): In advanced cases where the bone has collapsed, partial or total shoulder replacement may be performed to restore joint function.
- Resurfacing Hemiarthroplasty: A less invasive option to replace only the damaged portion of the humeral head, preserving more of the original bone.
Dr McGrath carefully considers each case and discusses the most suitable surgical options with patients based on the stage of AVN and individual needs. Post-operative rehabilitation is crucial for recovery.
When to See Dr Ben McGrath for Shoulder Pain
If shoulder pain persists, worsens over time, or limits your ability to perform daily activities, a consultation with Dr McGrath can provide an accurate diagnosis and effective treatment options tailored to your needs.
FAQs About Avascular Necrosis of the Shoulder
While it is not always preventable, managing risk factors like limiting alcohol intake, avoiding high-dose steroid use, and treating underlying medical conditions may reduce the risk.
Recovery times vary depending on the type of surgery, but most patients regain function within 3–6 months with proper rehabilitation.
Not always. In the early stages, non-surgical treatments may help slow progression and relieve symptoms. Surgery is typically reserved for advanced stages.