AVASCULAR NECROSIS

Avascular necrosis is a focal infarct of bone that may be caused by specific etiologic factors or may be idiopathic. It can cause pain, limitation of motion, joint collapse, and secondary osteoarthritis. It results from the temporary or permanent loss of blood supply to the bone, blood supply is cut off, the bone tissue dies and the bone collapses.

This condition may happen in any bone. It most commonly happens in the ends of a long bone. It may affect one bone, several bones at one time, or different bones at different times.

CAUSES:

Avascular necrosis may be the result of the following:

• Injury
• Fracture
• Damage to blood vessels
• Long-term use of medicines, such as corticosteroids
• Excessive, long-term use of alcohol
• Specific chronic medical conditions

RISK FACTORS 

• Injury

• Steroid use

• Gaucher disease

• Alcohol use

• Blood disorders, such as sickle cell anemia

• Chemotherapy

• Pancreatitis

• Hyperlipidemia

• Autoimmune disease

• HIV

SYMPTOMS:

General symptoms: Pain increases gradually,pain increases and is exacerbated by motion and weight bearing and is relieved by rest.

Limited range of motion due to pain.

JOINT-SPECIFIC SYMPTOMS:

Osteonecrosis of the hip - Causes groin pain that may radiate down the thigh or into the buttock. Motion becomes limited, and a limp usually develops).

Osteonecrosis of the knee- Sudden knee pain without preceding trauma; the sudden onset and the location of pain may help differentiate it from classical osteonecrosis. This pain is most often on the medial side of the femoral condyle or tibial plateau and manifests with tenderness, noninflammatory joint effusion, painful motion, and a limp.

Osteonecrosis of the humeral head -  often causes less pain and disability than hip and knee involvement, but pain and disability may be significant in patients who use crutches to bear weight.

DIAGNOSED:

• X-ray.

• Computed tomography scan

• Magnetic resonance imaging (MRI).

• Radionuclide bone scan.

• Biopsy

• Functional evaluation of bone.

HOMOEOPATHIC MANAGEMENT: 

1.Syphilinum –  The most dominant feature for selecting Syphilinum in any given case of AVN is the worsening of bone pains at night. The person feels pain throughtout the night and is unable to sleep. The pains may compel the patient to walk which seems to bring relief. The person feels relatively better during the day.  AVN cases is a specific pattern regarding the appearance and disappearance of pains. gradual increase in bone pains and in the same way, a gradual disappearance of pains. Syphilinum is worsening of pain because of heat and some relief by applying cold water. History of excessive alcoholism may be present in persons requiring Syphilinum.

2. Strontium Carb – Strontium Carb is a natural remedy recommended for cases of AVN of femoral bone. Those needing it have worsening of pain due to cold air. Besides AVN, it is a prominent medicine to deal with cases of weak and brittle bones prone to break easily.

2. Natrum Sulph –  Natrum Sulph is one of the most beneficial medicines when dealing with hip joint AVN. The patient mainly complains of pain during movement or in a stooping position.

4. Fluoric Acid – most effective for the necrosis of long bones. The bones include humerus (bone in the upper arm), femur (bone in the thigh) and tibia (bone in front of the leg). Fluoric Acid is mainly used to halt necrosis appearing in long bones. The persons needing Fluoric Acid usually have excess body heat and the external heat worsens the condition. Apart from long bones, necrosis of the bones of the ear (which are rarely involved) are also covered

5. Asafoetida – Asafoetida is wonderful medicine for AVN of tibia (bone in the leg). There is worsening of pain at night along with over-sensitivity in bones. The bone pain can be darting, sharp or stitching in nature.

6. Silicea – necrosis of jaw, wrist bones, hand bones, feet bones, ankle, knees and long bones —including humerus (bone in the upper arm), femur (bone in the thigh) and tibia (bone in front of leg) — are the sites of action for using Silicea. The general symptom for using Silicea is sensitivity to cold air when bone pain worsens even from the slightest exposure to cold air. Warmth brings relief.

7. Aurum Metallicum – necrosis in nasal and palatine bones. The mastoid bone is also the site that benefits from the use of Aurum Met. The patient complains of pains at night and may suffer from extremely offensive odor from the mouth and nose along with pain. The patient may also feel depressed with a high degree of sadness.

10. Hekla Lava – Avascular Necrosis of the jaw when the jaw destruction is accompanied by marked facial nerve pain.