Category: Uncategorized

Avascular Necrosis/ Osteonecrosis Support Int’l

https://www.facebook.com/groups/DeadBoneDiseaseAVN/?ref=share

A major reason many  put  off a joint replacement surgery can be summed up in one word: fear.

Let’s be real here any joint replacement surgery is not easy nor minor.

The feeling of anxiety leading up to and going to surgery is normal, just don’t get consumed by the fear. It is known as preoperative or preoperational anxiety , is incredibly common. A lot of patients who know they will have surgery will start to experience it. Anxiety before surgery is essentially described as unpleasant stress, uneasiness, or tension that results from the fears and doubts of patients.

Speaking for myself , I get a bit anxious before any surgical procedure. I think it would be abnormal to not be a bit anxious. But I have taught myself ways to breathe, meditate and remain calm so the fear never consumes me because that type of fear seems unhealthy.

I personally haven’t needed a joint replacement as my osteonecrosis has been stage 1-2 for 6 years now that’s to prp injections and be changing the way I eat and take care of myself. But I have had pre surgical nerves before a few other surgeries.

I do believe in a positive attitude but I also believe in being educated on what is going to be happening to me.

What Causes Fear of Surgery?

There are numerous reasons why someone may be scared of surgery. The most common reasons are:

Fear of the unknown

Worrying about the surgery not working

Pain

Fear of the anesthetic

Having to recover around strangers

Losing control

Not being able to recover

Death

 

It is perfectly normal to experience  pre-surgery anxiety. The intensity of this fear will depend on a range of factors, including:

The experiences people have had in hospitals in the past

Their personal psychology

Age

 

Three Levels of Anxiety before Surgery

According to specialists, everyone experiences a degree of anxiety before going into spine surgery. However, they agree that there are three separate levels of that anxiety:

 

Low level, which happens in those people who are inclined to ignore any signs of impending danger. This can be anyone from the eternal optimist to someone with a schizoid personality disorder.

Moderate anxiety, which is seen in people who tend to respond directly to any information they are given. This means that the information provided about the potential complications of surgery is likely to make them scared of surgery, but this can rapidly be resolved by providing them with information on the rarity of these complications occurring.

High anxiety, found in people who have a neurotic predisposition or those who have an almost irrational fear of surgery and bodily harm.

 

The Impact of Pre Surgery Anxiety

Being afraid of going into surgery has an impact on people in a variety of different ways. These include:

 

Psychological effects, including cognitive and behavioral changes such as aggression, nervousness, apprehension, and tension. Sometimes, this makes the patients finding it impossible to follow instructions and others becoming so aggressive that they may pose a danger to others.

Physical effects, which include things such as heightened senses, nervous diarrhea before surgery, a fever, hypertension, and tachycardia. Peripheral vasoconstriction is also common

 

Tips on How to Stay Calm Before Surgery

Thankfully, there are numerous things that you can do in order to remain calm, or experience a healthy level of anxiety and no more, before a surgery.

 

Trust yourself.

 

When you feel anxious, you become fearful of others. Psychologically speaking, this actually translates into paranoia against yourself. You need to trust the fact that you know your own body and that you can listen to it and understand what it needs.

 

    Develop trust in your medical team.

 

If you want to reduce your overall fear and anxiety, it is hugely important that you trust the practitioners involved in your care. Trust and anxiety are each other’s opposites. If you feel that you can trust the nurses and doctors who are trying to help you, then you will immediately start to feel in control again

 

 

    Educate yourself.

 

Once you know what your medical condition is, you should research it properly. This can help you to overcome the fear of the surgery, the hospital, and the condition itself. At the same time, be aware of the fact that doing research about your medical condition can also increase anxiety.

 

 

Make use of relaxation techniques.

 

There are lots of good relaxation techniques you can use. Muscle relaxations, breathing exercises, meditations, are all excellent techniques.

 

 

    Join a support group.

 

There are lots of really good support groups out there waiting to welcome you.

Understand is that it is ok to be afraid, we are human, just don’t allow the fear or anxiety you may be feeling control you.

 

 

 

Make sure you have pre planned for your surgery to make your home life easier when you return .If you had joint replacements, get rifd of all throw rugs so you don’t trip on them. Move objects from your path so you can use a walker with ease if necessary. Try some meditation, there are many things you can try to help calm you.

 

If you need support please join us if you have osteonecrosis aka avn

We at Avascular Necrosis / Osteonecrosis Support Int’l. will help you get through it, we are more of a family .  And we know what your goin through.

 

Wishing you a pain free day

 

Medical research has identified a number of risk factors associated with AVN.

Interestingly, not everyone who has a risk factor gets AVN and not everyone with AVN has an easily identifiable risk factor, meaning the cause is unknown or idiopathic.

People who have a fracture of the proximal humerus (ball part of the shoulder) are at risk for AVN.

With a fracture of the proximal humerus the blood supply can be disrupted and loss of the normal blood flow to the bone may cause it to eventually die and become necrotic.

The more extensive the fracture the more likely is this development of AVN.

Another common cause of AVN is the effect of steroids given for other conditions.

The steroids are believed to damage the health of the cells which make bone in the humeral head and when they die the sequence of AVN occurs.

Other causes of AVN can be radiation or chemotherapy treatment in the case of cancer.

Other rare causes include sickle cell disease, Gaucher’s disease, Caisson’s disease (also known as diver’s disease or the bends:

This is due to sudden change in water pressure in deep sea diving where nitrogen bubbles form in the blood and damage the blood supply to the humeral head). 

AVN Avascular Necrosis aka Osteonecrosis ON

usually presents as pain and may also be associated with noise and crunching sensation (crepitation) in the shoulder with movement.

Movement may be limited due to pain. About 50% of individuals who develop atraumatic (without a fracture) AVN in the shoulder will also have involvement of other joints.

 

In its early stages AVN may not be apparent on a plain x-ray but it can be seen on an MRI (described above).

As it progresses with collapse of the humeral head and eventual arthritis it is clearly seen on an x-ray (see figures below).

Stage 1 is a shoulder with a normal X-ray but signal changes on MRI showing subchondral edema.

Stage 2 is a shoulder with more whitened bone called sclerosis, near the joint surface (subchondral).

Stage 3 demonstrates a crescent sign or collapse or fracture of the subchondral bone.

Stage 4 demonstrates flattening of the humeral head from advanced collapse.

Stage 5 or end-stage AVN demonstrates advanced collapse of the humerus with degenerative changes of the glenoid (arthritis).

 

A study that looked at 200 shoulders with AVN found that about 40% of shoulders with early AVN progressed in 3 years to advanced AVN.

 

Patients that presented with later-stage AVN, 55-80% of patients (depending on how late the stage) progressed to advanced AVN6.

Drilling of the humeral head, called core decompression, is a treatment which may be helpful in the early stages of AVN before the humeral head collapses.

It is believed that pressure in the bone goes up when the blood supply is lost and that pain can be relieved by decompressing the bone by drilling into it.

This is called core decompression. This may also stimulate better blood supply and faster healing in the humeral head.

Facts

• A condition caused by interruption of blood supply to humeral head

• Pathophysiology

◦ pathoanatomy 

▪ decreased blood supply to humeral head leading to death of cells in bony matrix.

▪ bone is resorbed and remodeled, causing subchondral bone collapse and may lead to joint incongruity and arthritic changes

◦ etiology similar to hip

▪ Remember ASEPTIC mneumonic 

▪ Alcohol, AIDS

▪ Steroids (most common), Sickle, SLE

▪ Erlenmeyer flask (Gaucher’s)

▪ Pancreatitis

▪ Trauma

▪ Idiopathic/ Infection

▪ Caisson’s (the bends)

▪

▪ may be atraumatic

▪ posttraumatic

▪ four-part fracture-dislocations approach 100% AVN

▪ displaced four-part fractures ~45% AVN

▪ valgus impacted four-part ~11% AVN

▪ three-part ~14% AVN

• Prognosis

◦ related to stage of disease

Anatomy

• Blood supply

◦ Humeral head

▪ ascending branch of anterior humeral circumflex artery and arcuate artery

▪ provides blood supply to humeral head

▪ vessel runs parallel to lateral aspect of tendon of long head of biceps in the bicipital groove

▪ beware not to injure when plating proximal humerus fractures

▪ arcuate artery is the interosseous continuation of ascending branch of anterior humeral circumflex artery and penetrates the bone of the humeral head

▪ provides 35% of blood supply to humeral head

▪ posterior humeral circumflex artery

▪ most current literature supports this as providing the main blood supply to humeral head 

▪ provides 65% of blood supply 

Classification

 

Cruess Classification (stages)

Stage I

Normal x-ray. Changes on MRI. Core decompression.

 

Stage II

Sclerosis (wedged, mottled), osteopenia. Core decompression.

 

Stage III

Crescent sign indicating a subchondral fracture. Resurfacing or hemiarthroplasty.

 

Stage IV

Flattening and collapse. Resurfacing or hemiarthroplasty.

 

Stage V

Degenerative changes extend to glenoid. TSA.

 

 

Presentation

• Symptoms

◦ insidious onset of shoulder pain

▪ often without a clear inciting event

◦ pain, loss of motion, crepitus, and weakness

• Physical exam

◦ limited range of motion

◦ crepitus

◦ weakness of the rotator cuff and deltoid muscles

Imaging

• Radiographs

◦ recommended views

▪ five views of shoulder (shown best in neutral rotation AP)

◦ findings

▪ no findings on radiograph at onset of disease process

▪ osteolytic lesion develops on radiograph demonstrating resorption of subchondral necrosis

▪ most common initial site is superior middle portion of humeral head

▪ crescent sign demonstrates subchondral collapse

▪ may progress to depression of articular surface and consequent arthritic changes.

• MRI

◦ preferred imaging modality

▪ ~100% sensitivity in detection

◦ will demonstrate edema at the site of subchondral sclerosis 

Treatment

• Nonoperative

◦ pain medications, activity modification, physical therapy

▪ indications

▪ first line of treatment

▪ technique

▪ physical therapy

▪ restrict overhead activity and manual labor

• Operative

◦ core decompression + arthroscopy (confirm integrity of cartilage)  

▪ indications

▪ early disease (precollapse Cruess Stage I and II)

◦ humeral head resurfacing

▪ indications

▪ Stage III disease with focal chondral defects, and sufficient remaining epiphyseal bone stock for fixation.

◦ hemiarthroplasty  

▪ indications

▪ moderate disease (Cruess Stage III and IV)

◦ total shoulder arthroplasty 

▪ indications

▪ advance stage (Cruess V)

References

1. Mont MA, Payman RK, Laporte DM, Petri M, Jones LC, Hungerford DS: Atraumatic osteonecrosis of the humeral head. J Rheumatol 2000; 27:1766-1773
2. Hasan S, Romeo A: Nontraumatic osteonecrosis of the humeral head J Shoulder Elbow Surg 2008; 281-298
3. CruessRL: Corticosteroid-induced osteonecrosis of the humeralhead. Orthop Clin North Am 1985; 16:789-796.
4. LaPorteDM, MontMA, MohanV, JonesLC, HungerfordDS: Multifocal osteonecrosis. J Rheumatol 1998; 25:1968-1974.
5. CruessRL: Experience with steroid-induced avascular necrosis of the shoulder and etiologic considerations regarding osteonecrosis of the hip. Clin Orthop Relat Res 1978; 130:86-93
6. HattrupSJ, CofieldRH Osteonecrosis of the humeral head: Relationship of disease stage, extent, and cause to natural history. J Shoulder Elbow Surg 1999; 8:559-564.
7. Feeley BT, Fealy S, Dines DM, Warren RF, Craig EV. Hemiarthroplasty and total shoulder arthroplasty for avascular necrosis of the humeral head. J Shoulder Elbow Surg 2008;17(5): 689-694.
8. Harreld KL, Marker DR, Wiesler ER, Shafiq B, Mont M. Osteonecrosis of the Humeral Head. J Am Academy of Orthop Surgeons 2009;17(6): 345-355.

While each person’s experience with Osteonecrosis is different, I want to make sure you have the right information and support you need to live life your best life in spite of osteonecrosis.

There are ways I was able to control my pain, lower overall inflammation in my body which helped my pain.

Also did you know that for many people statins helped as well?

It was time I stopped just being a patient , and I became an advocate and patient leader. It was time to take a personal approach to my health many doctors didn’t understand how I felt, some often seemed as if I was exaggerating or making it up.

This pain wasn’t in my head, and if anything I’m downplaying my pain vs telling you doctors how terrible it is on a constant and daily basis.

Let’s face it when we have chronic pain we don’t always want to cook all day . But I found out trying to save time and energy by grabbing a pizza or burger isn’t helping my pain.

The more junk fats like fast food, processed garbage I removed from my life over time the better I was feeling.

It’s not a cure or a easy fix.

But it’s not hard and it’s delicious.

I’m the main cook in our family. So I prepared meals that have less and no meat more often.

From meatless Monday to now meatless M-W-S

And it was a great success , soon we only ate meat or chicken 1x a week and fish 1x -2 x a week.

We did eat eggs .

Before I knew it some weeks we didn’t eat meat or poultry at all.

We did have fish like cod , tuna, haddock ,crab,shrimp or tuna steaks.

We didn’t care for salmon much.

I also started a pain journal it had what I ate- what I did – my stress level- pain level

Whether you’ve been battling pain for more than a decade or you’re just starting to deal with consistent aches pains and stiff soreness, a pain journal can help you document what you are feeling from day to day.

Your pain journal is where you write down everything relating to your chronic pain what kind of pain you have, what level of pain you are experiencing, what you were doing when you were in pain, what you ate and so on.

Chronic Pain Journal Helps

This information is useful both for you and your doctor. It can be used to help identify patterns of pain, such as time of day or level of stress, or pain triggers from certain activities.

A pain journal can also show what doesn’t increase your pain, which can help you make better decisions about how you spend your day. At the very least, it can be a good reference when memory doesn’t serve you (for example, if you’re not sure how to answer when your doctor asks if your pain is worse after lunch).

Usually pain journal are set up like this.

• Give your pain a scale rating. Most pain scales use the 0-10 rating system, with 0 representing no pain and 10 representing the worst imaginable pain. Your pain will usually fall somewhere in between.

• Use pain descriptor words. Is your pain burning? Stabbing? Tingling? Pulsating? Constant? Using pain descriptor words in your journal can help you track changes and patterns in your pain quality.

• It can also help doctors pinpoint your type of pain.

• Track the time of day pain occurs. Do you hurt more in the morning or the evening? How are your afternoons?

• Write down what you ate and drank that day. Foods and beverages may contribute to or worsen the pain you are experiencing. Jot down everything you ingested food and beverages everyday.You will see a pattern.

• Describe your mood. It’s also important to note your mental state and how you feel when experiencing pain. Are you depressed? Anxious? Fatigued? Obviously, the pain might be triggering these emotions, and your doctor may recommend you see a mental health specialist to deal with the feelings that arise as a result of your chronic pain.

• Note what you are doing when your pain begins. Did you just get out of bed, or had you been sitting for a while when your pain started? Were you exercising or overusing certain muscles in your body? Write down how you feel after activities, such as walking the dog or playing with the kids.

• Look at elements that might contribute to your pain. Think about the external factors that may add to the pain, such as if you suffer from stiff joints; does this happen when it’s raining or cold outside

• Note if you take pain medication does it help? Does it ease pain, take it away do nothing .

It seems like a lot of work but actually it takes just a few days to get it down.

And it’s a valuable tool.

Often a lot of what we eat makes pain worse. Because it causes inflammation in the body.

Basic inflammation is normal chronic inflammation is not.

©Debla2019