Understanding Avascular Necrosis and Its Impact on Numbness in Extremities

Avascular necrosis (AVN) is a condition that can cause severe pain and disability. It particularly affects the joints and occurs when blood flow to a bone is disrupted, leading to the death of bone tissue. In my right hand I have advanced AVN, as both my Lunate and Scaphoid bone are dead. This can be serious, resulting in the collapse of the bone structure and the need for joint replacement surgery. In my wrist, I've been told that a joint replacement surgery isn't needed. An often overlooked symptom of AVN is numbness in the extremities. In this post, we will discuss the link between avascular necrosis and numbness, highlighting its causes, symptoms, and treatment options.

What is Avascular Necrosis?

Avascular necrosis, also known as osteonecrosis, mainly affects the hip, knee, and shoulder joints. My AVN is in my Talus bone and the wrist bones. The disruption of blood supply causes the bone cells to die. Causes of AVN include:

• Trauma: Fractures or dislocations can compromise blood flow.

• Corticosteroids: Long-term use can increase the risk of AVN, with studies showing that around 30% of patients receiving high doses develop the condition.

• Alcohol Consumption: Excessive drinking can damage blood vessels.

• Medical Conditions: Diseases like lupus, hyperparathyroidism, and sickle cell anemia can contribute as well.

• There are idiopathic cases also.

  
  

When blood flow is cut off, bones do not receive essential nutrients and oxygen, causing them to deteriorate. Over time, individuals may experience joint pain, stiffness, and limited mobility.

Symptoms of Avascular Necrosis

Symptoms of avascular necrosis can vary significantly based on the disease's progression. Initially, mild pain may come and go, but as it advances, pain can become severe and constant, especially during activity. Common symptoms include:

• Joint pain and stiffness

• Limited range of motion

• Swelling around the affected joint

• Numbness or tingling in the extremities

  
  

Numbness is particularly alarming, as it may indicate nerve involvement or other complications with AVN. My level of numbness in the right hand is extremely painful.

The Connection Between Avascular Necrosis and Numbness

Numbness in the extremities linked to avascular necrosis can occur due to several factors. The collapse or misalignment of bones can lead to nerve compression. For example, if a bone in the hip joint collapses, it might press against nearby nerves, causing sensations of numbness or tingling. Additionally, a study from the Journal of Bone and Joint Surgery found that about 25% of patients with AVN experienced nerve complications due to reduced blood flow, which is crucial for nerve health. My hand numbness has only started in the last few weeks.

Diagnosis of Avascular Necrosis

A diagnosis of avascular necrosis typically involves a detailed medical history, physical examination, and imaging tests. My doctors used X-rays, MRI scans, and CT scans to examine the bones and joints effectively.

In cases where numbness is present, further tests may be necessary. Electromyography (EMG) or nerve conduction studies can assess nerve function and determine if any nerve damage or compression is occurring. I hope that I don't have to take another one of these tests. They are painful and I have enough pain.

Treatment Options for Avascular Necrosis

The treatment approach for avascular necrosis largely depends on the severity of the condition. Early-stage AVN may be managed with conservative methods, while more advanced cases may necessitate surgical options.

Conservative Treatments

1. Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) can alleviate pain and reduce inflammation. Evidence shows that regular NSAID use can decrease pain levels by around 50% in some patients. The problem with that is the possibility of damage to my kidneys.

   
   

2. Physical Therapy: A tailored program can enhance joint function and strengthen surrounding muscles, improving support.

   
   

3. Activity Modification: Decreasing weight-bearing activities can help lessen stress on the affected joint.

4. Braces can be worn to keep the joint from moving. My hand therapist gave me a custom-fit hard brace.

   
   

Surgical Treatments

For cases where conservative treatments do not provide relief, surgical options may be explored:

1. Core Decompression: This method involves removing part of the inner bone to decrease pressure and enhance blood flow. My surgeon told me that this isn't very effective. He doesn't do this procedure.

   
   

2. Bone Grafting: Healthy bone tissue may be transplanted to replace damaged areas.

   
   

3. Joint Replacement: In severe cases, joint replacement surgery may restore function and relieve pain, improving quality of life. That is usually not a first choice, though it may be when you have AVN in the hip. Hip replacements are commonly the fix.

4. In the case of my wrist, the surgeon said that he would perform a surgery that removes the Lunate, Scaphoid, and Triquetrum. This is called Proximal Row Carpectomy.

   
   

Addressing Numbness in Extremities

If you notice numbness in your extremities due to avascular necrosis, it is vital to include this symptom in your treatment plan. Consider these strategies:

• Regular Check-Ups: Stay in contact with your healthcare provider to monitor your condition and adjust treatment plans if necessary.

  
  

• Physical Therapy: Participate in exercises to enhance strength and flexibility, easing pressure on nerves.

  
  

• Pain Management: Collaborate with your doctor to identify effective pain management techniques that could also alleviate numbness.

  
  

• Lifestyle Changes: Embrace a healthy lifestyle that includes a balanced diet and regular exercise to improve bone health and circulation.

  
  

Final Thoughts on Avascular Necrosis

Avascular necrosis is a serious condition that can lead to significant pain and disability, especially when it affects the joints. Understanding the connection between avascular necrosis and numbness in the extremities is essential for effective management.

If you or someone you know shows symptoms of AVN, including numbness, seek medical advice promptly. Early diagnosis and intervention can greatly improve outcomes and quality of life.

A close-up view of a healthy joint model illustrating avascular necrosis

By staying informed, it's easier to navigate the challenges of avascular necrosis and strive toward a healthier, more active life.

My appointment with a hand surgeon is tomorrow afternoon. I'm counting the hours and minutes, because I really need relief from this pain and swelling. I'm ready for surgery.

Disclaimer: I'm not a medical expert. This post contains my experiences and opinions and is not meant to be taken as medical advice. If you have a medical concern, please consult your personal physician.