| Avascular Necrosis, Osteonecrosis and Disability Benefits |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
If you suffer from disabling Avascular Necrosis (AVN) or Osteonecrosis
and can no longer work a full time work week, I would be happy to help you
obtain your rightful Disability Benefits. You may be eligible for Social Security
Disability benefits, even if you will eventually recover.
Start by filling out the FREE online Social Security Disability Claim Evaluation
Form (see Tab, on Left Hand Navigation), calling me at 201-317-0610 or
emailing SsiHelp@ptd.net or sojlaw@ptd.net.
and can no longer work a full time work week, I would be happy to help you
obtain your rightful Disability Benefits. You may be eligible for Social Security
Disability benefits, even if you will eventually recover.
Start by filling out the FREE online Social Security Disability Claim Evaluation
Form (see Tab, on Left Hand Navigation), calling me at 201-317-0610 or
emailing SsiHelp@ptd.net or sojlaw@ptd.net.
Avascular necrosis (sometimes referred to as Kienbock Disease or
Osteonecrosis) is a disease resulting from the temporary or Without blood,
the permanent loss of the blood supply to the bones. Without blood, the
bone tissue dies and causes the bone to collapse. If the process bone
tissue dies and causes the bone to involves the bones near a joint, it often
leads to collapse of the joint surface. This disease also is known as
osteonecrosis, aseptic necrosis, and ischemic bone necrosis.
Although it can happen in any bone, avascular necrosis most commonly
affects the ends (epiphyses) of long bones such as the femur, the bone
extending from the knee joint to the hip joint. Other common sites include
the upper arm bone, knees, shoulders, and ankles. The disease may
affect just one bone, more than one bone at the same time, or more than
one bone at different times. Avascular necrosis usually affects people
between 30 and 50 years of age; about 10,000 to 20,000 people develop
avascular necrosis each year. Orthopaedic doctors most often diagnose
the disease. The effects can be devastating, causing significant and
chronic pain and limitations, as well as an inability to work any longer (for
assistance obtaining disability cash benefits while you can not work, obtain
your free Social Security Disability evaluation here).
The amount of disability that results from avascular necrosis depends on
what part of the bone is affected, how large an area is involved, and how
effectively the bone rebuilds itself. The process of bone rebuilding takes
place after an injury as well as during normal growth. Normally, bone
continuously breaks down and rebuilds - old bone is reabsorbed and
replaced with new bone. The process keeps the skeleton strong and helps
it to maintain a balance of minerals. In the course of avascular necrosis,
however, the healing process is usually ineffective and the bone tissues
break down faster than the body can repair them. If left untreated, the
disease progresses, the bone collapses, and the joint surface breaks
down, leading to pain and arthritis.
Avascular necrosis affects both men and women and affects people of all
ages. It is most common among people in their thirties and forties.
Depending on a person's risk factors and whether the underlying cause is
trauma, it also can affect younger or older people.
Causes
Avascular necrosis has several causes. Loss of blood supply to the bone
can be caused by an injury (trauma-related avascular necrosis or joint
dislocation) or by certain risk factors (nontraumatic avascular necrosis),
such as some medications (steroids), blood coagulation disorders, or
excessive alcohol use. Increased pressure within the bone also is
associated with avascular necrosis. The pressure within the bone causes
the blood vessels to narrow, making it hard for the vessels to deliver
enough blood to the bone cells.
Injury: When a joint is injured, as in a fracture or dislocation, the blood
vessels may be damaged. This can interfere with the blood circulation to
the bone and lead to trauma-related avascular necrosis. Studies suggest
that this type of avascular necrosis may develop in more than 20% of
people who dislocate their hip joint.
Steroid Medications: Corticosteroids such as prednisone are commonly
used to treat diseases in which there is inflammation, such as systemic
lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease,
and vasculitis. Studies suggest that long-term, systemic (oral or
intravenous) corticosteroid use is associated with 35% of all cases of
nontraumatic avascular necrosis. However, there is no known risk of
avascular necrosis associated with the limited use of steroids. Patients
should discuss concerns about steroid use with their doctor. Doctors aren't
sure exactly why the use of corticosteroids sometimes leads to avascular
necrosis. They may interfere with the body's ability to break down fatty
substances. These substances then build up in and clog the blood
vessels, causing them to narrow. This reduces the amount of blood that
gets to the bone. Some studies suggest that corticosteroid-related
avascular necrosis is more severe and more likely to affect both hips
(when occurring in the hip) than avascular necrosis resulting from other
causes.
Alcohol Use: Excessive alcohol use and corticosteroid use are two of the
most common causes of nontraumatic avascular necrosis. In people who
drink an excessive amount of alcohol, fatty substances may block blood
vessels, causing a decreased blood supply to the bones that results in
avascular necrosis.
Other Risk Factors: Other risk factors or conditions associated with
nontraumatic avascular necrosis include Gaucher's disease, pancreatitis,
radiation treatments and chemotherapy, decompression disease, and
blood disorders such as sickle cell disease.
Symptoms
In the early stages of avascular necrosis, patients may not have any
symptoms. As the disease progresses, however, most patients experience
joint pain - at first, only when putting weight on the affected joint, and then
even when resting. Pain usually develops gradually and may be mild or
severe. If avascular necrosis progresses and the bone and surrounding
joint surface collapse, pain may develop or increase dramatically. Pain
may be severe enough to limit the patient's range of motion in the affected
joint. In some cases, particularly those involving the hip, disabling
osteoarthritis may develop. The period of time between the first symptoms
and loss of joint function is different for each patient, ranging from several
months to more than a year.
Diagnosis
After performing a complete physical examination and asking about the
patient's medical history (for example, what health problems the patient
has had and for how long), the doctor may use one or more imaging
techniques to diagnose avascular necrosis. As with many other diseases,
early diagnosis increases the chances of treatment success.
X-Ray: An X-ray is a common tool that the doctor may use to help
diagnose the cause of joint pain. It is a simple way to produce pictures of
bones. The X-ray of a person with early avascular necrosis is likely to be
normal because X-rays are not sensitive enough to detect the bone
changes in the early stages of the disease. X-rays can show bone damage
in the later stages, and once the diagnosis is made, they are often used to
monitor the course of the condition.
Magnetic Resonance Imaging (MRI): MRI is quickly becoming a
common method for diagnosing avascular necrosis. Unlike X-rays, bone
scans, and CT (computed/computerized tomography) scans, MRI detects
chemical changes in the bone marrow and can show avascular necrosis in
its earliest stages. MRI provides the doctor with a picture of the area
affected and the bone rebuilding process. In addition, MRI may show
diseased areas that are not yet causing any symptoms.
Bone Scan: Also known as bone scintigraphy, bone scans are used most
commonly in patients who have normal X-rays. A harmless radioactive dye
is injected into the affected bone and a picture of the bone is taken with a
special camera. The picture shows how the dye travels through the bone
and where normal bone formation is occurring. A single bone scan finds all
areas in the body that are affected, thus reducing the need to expose the
patient to more radiation. Bone scans do not detect avascular necrosis at
the earliest stages.
Computed/Computerized Tomography (CT Scan): A CT scan is an
imaging technique that provides the doctor with a three-dimensional
picture of the bone. It also shows "slices" of the bone, making the picture
much clearer than X-rays and bone scans. Some doctors disagree about
the usefulness of this test to diagnose avascular necrosis. Although a
diagnosis usually can be made without a CT scan, the technique may be
useful in determining the extent of bone damage.
Biopsy: A biopsy is a surgical procedure in which tissue from the affected
bone is removed and studied. Although a biopsy is a conclusive way to
diagnose avascular necrosis, it is rarely used because it requires surgery.
Functional Evaluation of Bone: Tests to measure the pressure inside a
bone may be used when the doctor strongly suspects that a patient has
avascular necrosis, despite normal results of X-rays, bone scans, and
MRIs. These tests are very sensitive for detecting increased pressure
within the bone, but they require surgery.
Treatments
Appropriate treatment for avascular necrosis is necessary to keep joints
from breaking down. If untreated, most patients will experience severe pain
and limitation in movement within 2 years. Several treatments are available
that can help prevent further bone and joint damage and reduce pain. To
determine the most appropriate treatment, the doctor considers the
following aspects of a patient's disease:
The goal in treating avascular necrosis is to improve the patient's use of
the affected joint, stop further damage to the bone, and ensure bone and
joint survival. To reach these goals, the doctor may use one or more of the
following treatments.
Conservative Treatment.
Medicines to reduce fatty substances (lipids) that increase with
corticosteroid treatment or to reduce blood clotting in the presence of
clotting disorders. Nonsteroidal anti-inflammatory drugs may also be
prescribed to reduce pain.
Reduced weight bearing.
If avascular necrosis is diagnosed early, the doctor may begin treatment
by having the patient remove weight from the affected joint. The doctor
may recommend limiting activities or using crutches. In some cases,
reduced weight bearing can slow the damage caused by avascular
necrosis and permit natural healing. When combined with medication to
reduce pain, reduced weight bearing can be an effective way to avoid or
delay surgery for some patients.
Range-of-motion exercises may be prescribed to maintain or improve
joint range of motion.
Electrical stimulation to induce bone growth.
Conservative treatments have been used experimentally alone or in
combination. However, these treatments rarely provide lasting
improvement. Therefore, most patients will eventually need surgery to
repair the joint permanently.
Surgical Treatment :
Core decompression. This surgical procedure removes the inner layer
of bone, which reduces pressure within the bone, increases blood flow to
the bone, and allows more blood vessels to form. Core decompression
works best in people who are in the earliest stages of avascular necrosis,
often before the collapse of the joint. This procedure sometimes can
reduce pain and slow the progression of bone and joint destruction in
these patients.
Osteotomy. This surgical procedure reshapes the bone to reduce stress
on the affected area. There is a lengthy recovery period, and the patient's
activities are very limited for 3 to 12 months after an osteotomy. This
procedure is most effective for patients with advanced avascular necrosis
and those with a large area of affected bone.
Bone graft. A bone graft may be used to support a joint after core
decompression. Bone grafting is surgery that transplants healthy bone
from one part of the patient, such as the leg, to the diseased area.
Commonly, grafts (called vascular grafts) that include an artery and veins
are used to increase the blood supply to the affected area. There is a
lengthy recovery period after a bone graft, usually from 6 to 12 months.
This procedure is complex and its effectiveness is not yet proven. Clinical
studies are underway to determine its effectiveness.
Arthroplasty/total joint replacement. Total joint replacement is the
treatment of choice in late-stage avascular necrosis and when the joint is
destroyed. In this surgery, the diseased joint is replaced with artificial
parts. It may be recommended for people who are not good candidates for
other treatments, such as patients who do not do well with repeated
attempts to preserve the joint. Various types of replacements are
available, and people should discuss specific needs with their doctor.
For most people with avascular necrosis, treatment is an ongoing process.
Doctors may first recommend the least complex and invasive procedure,
such as protecting the joint by limiting movement, and watch the effect on
the patient's condition. Other treatments then may be used to prevent
further bone destruction and reduce pain. It is important that patients
carefully follow instructions about activity limitations and work closely with
their doctor to ensure that appropriate treatments are used.
The information in this article has been made available by the National Institute of
Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health. Article
Created: 2001-01-01 Article Reviewed: 2005-07-21
Osteonecrosis) is a disease resulting from the temporary or Without blood,
the permanent loss of the blood supply to the bones. Without blood, the
bone tissue dies and causes the bone to collapse. If the process bone
tissue dies and causes the bone to involves the bones near a joint, it often
leads to collapse of the joint surface. This disease also is known as
osteonecrosis, aseptic necrosis, and ischemic bone necrosis.
Although it can happen in any bone, avascular necrosis most commonly
affects the ends (epiphyses) of long bones such as the femur, the bone
extending from the knee joint to the hip joint. Other common sites include
the upper arm bone, knees, shoulders, and ankles. The disease may
affect just one bone, more than one bone at the same time, or more than
one bone at different times. Avascular necrosis usually affects people
between 30 and 50 years of age; about 10,000 to 20,000 people develop
avascular necrosis each year. Orthopaedic doctors most often diagnose
the disease. The effects can be devastating, causing significant and
chronic pain and limitations, as well as an inability to work any longer (for
assistance obtaining disability cash benefits while you can not work, obtain
your free Social Security Disability evaluation here).
The amount of disability that results from avascular necrosis depends on
what part of the bone is affected, how large an area is involved, and how
effectively the bone rebuilds itself. The process of bone rebuilding takes
place after an injury as well as during normal growth. Normally, bone
continuously breaks down and rebuilds - old bone is reabsorbed and
replaced with new bone. The process keeps the skeleton strong and helps
it to maintain a balance of minerals. In the course of avascular necrosis,
however, the healing process is usually ineffective and the bone tissues
break down faster than the body can repair them. If left untreated, the
disease progresses, the bone collapses, and the joint surface breaks
down, leading to pain and arthritis.
Avascular necrosis affects both men and women and affects people of all
ages. It is most common among people in their thirties and forties.
Depending on a person's risk factors and whether the underlying cause is
trauma, it also can affect younger or older people.
Causes
Avascular necrosis has several causes. Loss of blood supply to the bone
can be caused by an injury (trauma-related avascular necrosis or joint
dislocation) or by certain risk factors (nontraumatic avascular necrosis),
such as some medications (steroids), blood coagulation disorders, or
excessive alcohol use. Increased pressure within the bone also is
associated with avascular necrosis. The pressure within the bone causes
the blood vessels to narrow, making it hard for the vessels to deliver
enough blood to the bone cells.
Injury: When a joint is injured, as in a fracture or dislocation, the blood
vessels may be damaged. This can interfere with the blood circulation to
the bone and lead to trauma-related avascular necrosis. Studies suggest
that this type of avascular necrosis may develop in more than 20% of
people who dislocate their hip joint.
Steroid Medications: Corticosteroids such as prednisone are commonly
used to treat diseases in which there is inflammation, such as systemic
lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease,
and vasculitis. Studies suggest that long-term, systemic (oral or
intravenous) corticosteroid use is associated with 35% of all cases of
nontraumatic avascular necrosis. However, there is no known risk of
avascular necrosis associated with the limited use of steroids. Patients
should discuss concerns about steroid use with their doctor. Doctors aren't
sure exactly why the use of corticosteroids sometimes leads to avascular
necrosis. They may interfere with the body's ability to break down fatty
substances. These substances then build up in and clog the blood
vessels, causing them to narrow. This reduces the amount of blood that
gets to the bone. Some studies suggest that corticosteroid-related
avascular necrosis is more severe and more likely to affect both hips
(when occurring in the hip) than avascular necrosis resulting from other
causes.
Alcohol Use: Excessive alcohol use and corticosteroid use are two of the
most common causes of nontraumatic avascular necrosis. In people who
drink an excessive amount of alcohol, fatty substances may block blood
vessels, causing a decreased blood supply to the bones that results in
avascular necrosis.
Other Risk Factors: Other risk factors or conditions associated with
nontraumatic avascular necrosis include Gaucher's disease, pancreatitis,
radiation treatments and chemotherapy, decompression disease, and
blood disorders such as sickle cell disease.
Symptoms
In the early stages of avascular necrosis, patients may not have any
symptoms. As the disease progresses, however, most patients experience
joint pain - at first, only when putting weight on the affected joint, and then
even when resting. Pain usually develops gradually and may be mild or
severe. If avascular necrosis progresses and the bone and surrounding
joint surface collapse, pain may develop or increase dramatically. Pain
may be severe enough to limit the patient's range of motion in the affected
joint. In some cases, particularly those involving the hip, disabling
osteoarthritis may develop. The period of time between the first symptoms
and loss of joint function is different for each patient, ranging from several
months to more than a year.
Diagnosis
After performing a complete physical examination and asking about the
patient's medical history (for example, what health problems the patient
has had and for how long), the doctor may use one or more imaging
techniques to diagnose avascular necrosis. As with many other diseases,
early diagnosis increases the chances of treatment success.
X-Ray: An X-ray is a common tool that the doctor may use to help
diagnose the cause of joint pain. It is a simple way to produce pictures of
bones. The X-ray of a person with early avascular necrosis is likely to be
normal because X-rays are not sensitive enough to detect the bone
changes in the early stages of the disease. X-rays can show bone damage
in the later stages, and once the diagnosis is made, they are often used to
monitor the course of the condition.
Magnetic Resonance Imaging (MRI): MRI is quickly becoming a
common method for diagnosing avascular necrosis. Unlike X-rays, bone
scans, and CT (computed/computerized tomography) scans, MRI detects
chemical changes in the bone marrow and can show avascular necrosis in
its earliest stages. MRI provides the doctor with a picture of the area
affected and the bone rebuilding process. In addition, MRI may show
diseased areas that are not yet causing any symptoms.
Bone Scan: Also known as bone scintigraphy, bone scans are used most
commonly in patients who have normal X-rays. A harmless radioactive dye
is injected into the affected bone and a picture of the bone is taken with a
special camera. The picture shows how the dye travels through the bone
and where normal bone formation is occurring. A single bone scan finds all
areas in the body that are affected, thus reducing the need to expose the
patient to more radiation. Bone scans do not detect avascular necrosis at
the earliest stages.
Computed/Computerized Tomography (CT Scan): A CT scan is an
imaging technique that provides the doctor with a three-dimensional
picture of the bone. It also shows "slices" of the bone, making the picture
much clearer than X-rays and bone scans. Some doctors disagree about
the usefulness of this test to diagnose avascular necrosis. Although a
diagnosis usually can be made without a CT scan, the technique may be
useful in determining the extent of bone damage.
Biopsy: A biopsy is a surgical procedure in which tissue from the affected
bone is removed and studied. Although a biopsy is a conclusive way to
diagnose avascular necrosis, it is rarely used because it requires surgery.
Functional Evaluation of Bone: Tests to measure the pressure inside a
bone may be used when the doctor strongly suspects that a patient has
avascular necrosis, despite normal results of X-rays, bone scans, and
MRIs. These tests are very sensitive for detecting increased pressure
within the bone, but they require surgery.
Treatments
Appropriate treatment for avascular necrosis is necessary to keep joints
from breaking down. If untreated, most patients will experience severe pain
and limitation in movement within 2 years. Several treatments are available
that can help prevent further bone and joint damage and reduce pain. To
determine the most appropriate treatment, the doctor considers the
following aspects of a patient's disease:
- The age of the patient
- The stage of the disease - early or late
- The location and amount of bone affected - a small or large area
- The underlying cause of avascular necrosis - with an ongoing cause
such as corticosteroid or alcohol use, treatment may not work
unless use of the substance is stopped.
The goal in treating avascular necrosis is to improve the patient's use of
the affected joint, stop further damage to the bone, and ensure bone and
joint survival. To reach these goals, the doctor may use one or more of the
following treatments.
Conservative Treatment.
Medicines to reduce fatty substances (lipids) that increase with
corticosteroid treatment or to reduce blood clotting in the presence of
clotting disorders. Nonsteroidal anti-inflammatory drugs may also be
prescribed to reduce pain.
Reduced weight bearing.
If avascular necrosis is diagnosed early, the doctor may begin treatment
by having the patient remove weight from the affected joint. The doctor
may recommend limiting activities or using crutches. In some cases,
reduced weight bearing can slow the damage caused by avascular
necrosis and permit natural healing. When combined with medication to
reduce pain, reduced weight bearing can be an effective way to avoid or
delay surgery for some patients.
Range-of-motion exercises may be prescribed to maintain or improve
joint range of motion.
Electrical stimulation to induce bone growth.
Conservative treatments have been used experimentally alone or in
combination. However, these treatments rarely provide lasting
improvement. Therefore, most patients will eventually need surgery to
repair the joint permanently.
Surgical Treatment :
Core decompression. This surgical procedure removes the inner layer
of bone, which reduces pressure within the bone, increases blood flow to
the bone, and allows more blood vessels to form. Core decompression
works best in people who are in the earliest stages of avascular necrosis,
often before the collapse of the joint. This procedure sometimes can
reduce pain and slow the progression of bone and joint destruction in
these patients.
Osteotomy. This surgical procedure reshapes the bone to reduce stress
on the affected area. There is a lengthy recovery period, and the patient's
activities are very limited for 3 to 12 months after an osteotomy. This
procedure is most effective for patients with advanced avascular necrosis
and those with a large area of affected bone.
Bone graft. A bone graft may be used to support a joint after core
decompression. Bone grafting is surgery that transplants healthy bone
from one part of the patient, such as the leg, to the diseased area.
Commonly, grafts (called vascular grafts) that include an artery and veins
are used to increase the blood supply to the affected area. There is a
lengthy recovery period after a bone graft, usually from 6 to 12 months.
This procedure is complex and its effectiveness is not yet proven. Clinical
studies are underway to determine its effectiveness.
Arthroplasty/total joint replacement. Total joint replacement is the
treatment of choice in late-stage avascular necrosis and when the joint is
destroyed. In this surgery, the diseased joint is replaced with artificial
parts. It may be recommended for people who are not good candidates for
other treatments, such as patients who do not do well with repeated
attempts to preserve the joint. Various types of replacements are
available, and people should discuss specific needs with their doctor.
For most people with avascular necrosis, treatment is an ongoing process.
Doctors may first recommend the least complex and invasive procedure,
such as protecting the joint by limiting movement, and watch the effect on
the patient's condition. Other treatments then may be used to prevent
further bone destruction and reduce pain. It is important that patients
carefully follow instructions about activity limitations and work closely with
their doctor to ensure that appropriate treatments are used.
The information in this article has been made available by the National Institute of
Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health. Article
Created: 2001-01-01 Article Reviewed: 2005-07-21
| What is Avascular Necrosis? Osteonecrosis? |
| MySsiCase.com |
| Brought to you by the Social Security Disability Law Office of Stephanie O. Joy, Esq. Helping clients, one-on-one, in all 50 U.S. States Ph: 201-317-0610 Email: SsiHelp@ptd.net Fax: 570-424-2384 |
