Ebooklet -Avascular Necrosis-2016

When Your An Advocate You Don’t Bully Other Advocates That Are Also Patients©

There are many great advocacy groups out there and then their are the few who want to be great but will sadly do more harm than good.

I was recently invited to join one because I have been an active advocate for Osteonecrosis for almost 6 years now.

And over those 6 years spoke to thousands of doctors – a few pro baseball players that developed Avn-on etc… so I do have a lot of knowledge on the subject and great resources.

It was against my better judgement to join but I thought ok I will give them a few tools and share my info with them to help them, then eventually step out of their group because I am very busy with my own advocacy work.

Well I joined yesterday after I was invited and when I was reading the posts on this new group page that was just 1-2 days old I was shocked to see all the copyright infringements.

My stuff pictures from my booklet and web site that I took the time to make and write about , all the research I did.

So I made a comment on how important for a group it is to create your own logos and ask before just using copyright work.

As some was my work and some were others that I know would not be happy with it being used without asking.

If they asked I may have said ok or I may not have.

Most of my things have the copy write and hidden watermarks on it.

I then was going to dinner and advised this group I would post a lot of info later that night.

When I went to post some really good info I found in my hundreds of files , I was removed from this public group and then am continually publicly bullied !

It’s a public group and I am the topic of their discussion for 2 days now .. Maybe they will get tired and eventually start advocating. Hopefully they aren’t one of these groups that talks about money all the time. Most advocates don’t do that.

I have to laugh because clearly these people have no idea that advocacy is about being leaders , patients having patience and instead it turned into a let’s pick on the chic we invited now that she is no longer in group we can talk about her and call her names .

I am shocked at the childish behavior by some people. Well most of leaders or so called leaders of this group.

Anyone who is in their groups better be prepared for drama town.

Thankfully I have a thick skin.

I am far better off without this group in my life. In fact they asked me to join or I never would have know they existed.

I’m a happy advocate, I work hard everyday at my advocacy and I get stuff done.

I don’t sit around waiting for others to do the work for me.

I create my logos and write my blogs I interview doctors- patients- leaders in community, elected officials etc…..

Everything I do and everything you see like my booklet – and the doctor directory I made for USA and and the International one I am and have been working on.

It is there because of all my hour’s of calls, notes and dedication.

I am proud to be the advocate I am and those who don’t like it can move on….

I am far better off with out you.

However many patients who may join that group may fall prey to their bullying and I feel sorry for them.

Because they may be newly diagnosed and just stumble on this group.

If you need a good advocacy group for your Avn drama free I have one.

We love our members and we have fun and educate : if your a bully you are not welcome and if you are in and bully someone you get a warning to be nice because we are all suffering with the same condition. If it happens again they are removed.

Not only does bullying and aggressive behavior create a difficult and hostile environment, it isolates people from getting the support they need.

Be constructive not destructive

If you bullies spent less time copying my stuff and talking about me and made your own your have a lot accomplished by now.

I am hoping they stop messaging me calling me awful names , swearing at me, men and women alike and please stop asking me for all my copyright stuff. I know what I have and I know all my copyrights and publications are legit.

There is a thing as research

Look it up!!!

It’s there.

All my stuff is copyright protected or permission maybe given but rarely and resources noted.

Why do slackers and bullies feel the need to just use other people’s art and print published copy for their benefit?

Being an advocate requires work and kindness

Also to patients you should never pay for being part of an advocacy group. You should never have to pay for anything and don’t be guilted into sob stories asking for money or items.

If you have Avn and need a group a good group that I promise will respect you and never ask you for anything to join check out

Unfortunately I will be removing some from my group who are now in a moderator or leadership position in that specific group. I hate to remove people from my support group.

But I feel so strongly about being kind to others that if you choose to be a leader of a group based on bullying I don’t think my group is a good fit for you.

If you feel that the group you chose to be a part of is not as you expected your welcome to join or return to ours. I’m all for being involved in one or several support groups. But not groups formed and run on bullying and always asking for money.

If you need a support group that supports you link is below

AvascularNecrosis/OsteonecrosisSupport Int’l

You deserve to be treated kindly respectfully and not bullied when you are already suffering.

Real advocates are busy advocating and raising awareness not harassing advocates or members.



❤️Deb Andio




Avascular Necrosis Shoulder

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.


• 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)



Idiopathic/ Infection

Caisson’s (the bends)

may be atraumatic


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


• 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 



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.




• 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


• 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.


◦ preferred imaging modality

~100% sensitivity in detection

◦ will demonstrate edema at the site of subchondral sclerosis 


• Nonoperative

◦ pain medications, activity modification, physical therapy


first line of treatment


physical therapy

restrict overhead activity and manual labor

• Operative

◦ core decompression + arthroscopy (confirm integrity of cartilage)  


early disease (precollapse Cruess Stage I and II)

◦ humeral head resurfacing


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

◦ hemiarthroplasty  


moderate disease (Cruess Stage III and IV)

◦ total shoulder arthroplasty 


advance stage (Cruess V)


  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.

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What your eating can be worsening your pain

Your eating what?

Before you take one more bite of that fast food lunch or dinner consider how it affects your osteoarthritis.

I am posting this because many with Avascular Necrosis/ Osteonecrosis also end up with osteoarthritis.

Did you know that research shows that diets high in saturated fat – found in red meat, butter, cheese, lard and processed foods – can weaken knee cartilage, making it more prone to damage.

Yep so start eating more plants

There was a study in 2017 published in Arthritis Care & Research, researchers followed more than 2,000 patients with OA for up to four years, checking disease progression  and diet at yearly intervals. Participants who ate the most fat, especially the saturated kind, showed increasing joint damage, whereas those who ate healthy fats like olive oil and avocados had little disease progression.

Another recent animal study showed that it even may harm the underlying bone, according to Yin Xiao, PhD, a professor at Queensland University of Technology in Australia and lead author of a 2017 study that looked at the effect of diet on OA.

“Our findings suggest that it’s not wear and tear but diet that has a lot to do with the onset of osteoarthritis,” he says.

Blame It On Inflammation

Fat’s not the only culprit, though. Sugar, refined carbs, red meat, processed food and corn and soybean oils can spark inflammation, too. Barry Sears, PhD, a long-time researcher in inflammatory nutrition, says eating them is “like throwing a match into a vat of gasoline.”

These foods also tend to pack on pounds, putting extra pressure on stressed joints. To make matters worse, body fat, especially the kind that collects around your belly, makes its own inflammatory proteins, perpetuating the cycle of inflammation even after you’ve sworn off junk food forever.

Fighting Back

The solution is to change the way you eat. Switching to an anti-inflammatory or Mediterranean-style diet can help you lose weight and significantly improve your joint, heart and  brain health without sacrificing good taste.

An anti-inflammatory diet is heavy on fruits and vegetables, whole grains, fish and healthy fats like olive oil, avocados and nuts. Poultry’s allowed  now and then and you can have one glass of red wine or beer a day. Off the menu, as you might expect, are sugar, red meat, and processed foods.

What sets this way of eating apart is that it actively fights inflammation, experts say.

“There are a variety of foods in the Mediterranean diet that are high in fiber, beta carotene, magnesium and omega 3s, all of which have been found to reduce inflammatory markers in human studies,” explains Michelle Babb, MS, RD, a Seattle-based nutrition educator.

“I’ve had [arthritis] patients who have been able to discontinue the use of non-steroidal anti-inflammatory drugs (NSAIDs) as a result of transitioning to a Mediterranean diet. Some even report a noticeable difference in pain in the first week.”

Even so, changing the way you eat can be daunting.

“Don’t expect your diet to change overnight,” advises Sotiria Everett, EdD, RD, an assistant professor at Stonybrook University Medical Center in New York. “Start by looking at what you’re eating now (a food diary is a great way to do this) and identifying areas where you can improve.”

But Babb doesn’t see a problem. Her patients “really enjoy this food plan and don’t feel it’s a hardship to follow it,” she says.

She admits it takes more work and advance planning than the drive-through and recommends prepping some food for the week in advance.

I personally can agree with this as when I stopped eating so much red meat and cut out sugar and most processed junk I felt much better .

And when I eat things that are not as healthy as they should be I feel more pain.

So try a plant based diet or as they suggest Mediterranean

You will be so glad you did.

This taken from article Arthritis Foundation Blog

Signs It May Be Time For Hip Replacement©

When you have tried everything an all non-surgical treatments stop relieving your chronic hip pain, or your pain reaches debilitating levels, hip replacement surgery may be the best option to relieve your discomfort, restore your mobility and improve your quality of life.

Hip pain due to Osteonecrosis is an increasing problem for many.

After time over-the-counter pain medications can lose their efficacy and chronic hip pain can quickly escalate often requiring prescription medications, physical therapy, and the use of canes or walkers to aid mobility.

If your pain is severe and debilitating, isn’t it time to do something about it.

Talk to your Doctor or Orthopedic because you don’t need to suffer and have a poor quality of life.

What Signs & Symptoms Indicate a Need for Hip Replacement Surgery?

Hip pain can have a number of causes, not all of which can be relieved by a hip joint replacement.

Among the listed causes of AVN are steroid use, trauma, hypertension, rheumatoid arthritis, and alcoholism, blood clot disorder, smoking, vasculitis Bisphosphonate use, Chemo or radiation or it could be idiopathic, meaning no cause can be determined. Certainly Napoli has had his share of wear and tear, being a catcher.

For instance, constant or long-lasting stiffness in your hip joint can be a sign of rheumatoid arthritis while pain that centers in the buttocks region and radiates down the leg may be related to sciatica.

However, many cases of hip pain and discomfort are directly related to your hip joint.

Symptoms and signs that it may be time for hip replacement surgery include:

• Mobility issues, especially if your level of mobility progressively worsens

• Persistent or recurring pain, swelling or discomfort in your hip

• Hip pain that worsens during rainy weather

• Inability to sleep due to hip pain and discomfort

• A “grating” feeling in your hip joint

• Increasing difficulty in climbing stairs or getting in and out of cars, bathtubs, and chairs

• OTC medications no longer effectively manage your hip pain

If you have any or all of these symptoms, talk to an orthopedic surgeon about the possible need for hip replacement surgery.

How Is a Diagnosis Made?

To determine if you are a good candidate for hip replacement surgery, you will need a thorough examination by an experienced orthopedic surgeon. This examination will include:

• A complete medical history evaluation, including any previous injuries or illnesses that could be contributing to your pain

• A physical assessment to determine your range of motion, pain level and the strength of your affected hip

Your orthopedic surgeon may also order additional medical testing, including MRIs and X-rays. If your surgeon decides that the next step is hip replacement surgery, be sure to discuss any questions or concerns you have about the surgery or recovery from hip replacement surgery.

What Do You Need to Know About Hip Replacement Surgical Procedures?

Potential candidates for hip replacement surgery need to know that the surgery is a time-tested procedure that has been used successfully for more than four decades to relieve chronic hip pain and improve both flexibility and mobility. More than 300,000 Americans opt for hip replacement surgery each year to rid themselves of hip pain and improve their quality of life.

Total hip replacement surgery, or total hip arthroplasty, uses a ball and socket prosthetic joint to replace your damaged one. Special metals, such as cobalt-chromium and titanium, and polyethylene plastics, are used to make your prosthetic joints. These materials are safe for use inside the body and are extremely durable and long lasting.

The procedure for your total hip replacement surgery will most likely include the following steps:

1 Separating your femur from your hip socket

2 Removing the damaged ball from the femur

3 Removing your damaged bone and cartilage

4 Inserting a metal shell into your pelvic bone socket and using bone grafting material to secure it

5 Completing the artificial socket by adding the plastic liner

6 Preparing your femur to receive the metal implant

7 Placing the metal implant into the hollowed end of your femur

8 Attaching a metal ball component to the stem

Hip replacement surgery is a very effective procedure, and most patients experience a dramatic reduction in pain and improvements in their mobility and stamina. With the proper recovery procedures and physical therapy, you should be able to enjoy walking, swimming, biking and other low-impact activities without impediment.


If you can no longer bare the pain or have problems walking talk to your ortho about your options.


Good luck

We’re praying for you

Text ©Debla2014