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Contents

Causes

Symptoms

Exams and Tests

Treatment

Support Groups

Outlook (Prognosis)

Possible Complications

When to Contact a Medical Professional

Prevention

Osteonecrosis is bone death caused by poor blood supply. It is most common in the hip and shoulder, but can affect other large joints such as the knee, elbow, wrist and ankle.

Causes

Osteonecrosis occurs when part of the bone does not get blood and dies. After a while, the bone can collapse. If osteonecrosis is not treated, the joint deteriorates, leading to severe arthritis.

Osteonecrosis can be caused by disease or by severe trauma, such as a fracture or dislocation, that affects the blood supply to the bone. Osteonecrosis can also occur without trauma or disease. This is called idiopathic -- meaning it occurs without any known cause.

The following are possible causes:

·         Using oral or intravenous steroids

·         Excessive alcohol use

·         Sickle cell disease

·         Radiation therapy

·         Gaucher disease

·         Decompression sickness from a lot of deep sea diving

·         Dislocation or fractures around a joint

·         Clotting disorders

·         HIV or taking HIV drugs

When osteonecrosis occurs in the shoulder joint, it is usually due to long-term treatment with steroids or a history of trauma to the shoulder.

Legg-Calvé-Perthes disease is a similar condition seen in children and adolescents.

Symptoms

There are no symptoms in the early stages. As bone damage worsens, you may have the following symptoms:

·         Pain in the joint that may increase over time and becomes severe if the bone collapses

·         Pain that occurs even at rest

·         Limited range of motion

·         Groin pain, if the hip joint is affected

·         Limping, if the condition occurs in or below the hip

Exams and Tests

Your health care provider will do a physical exam to find out if you have any diseases or conditions that may affect your bones. You will be asked about your symptoms and medical history.

Be sure to let your provider know about any medicines or vitamin supplements you are taking, even over-the-counter medicine.

After the exam, your provider will order one or more of the following tests:

·         X-ray

·         MRI

·         Bone scan

·         CT scan

Treatment

If your provider knows the cause of osteonecrosis, part of the treatment will be aimed at the underlying condition. For example, if a blood clotting disorder is the cause, treatment will consist, in part, of clot-dissolving medicine.

If the condition is caught early, you will take pain relievers and limit use of the affected area. This may include using crutches if your hip, knee, or ankle is affected. You may need to do range-of-motion exercises. Nonsurgical treatment can often slow the progression of osteonecrosis, but most people will need surgery.

Surgical options include:

·         A bone graft

·         A bone graft along with its blood supply (vascularized bone graft)

·         Cutting the bone and changing its alignment to relieve stress on the bone or joint (osteotomy)

·         Total joint replacement

·         Removing part of the inside of the bone (core decompression) to relieve pressure and allow new blood vessels to form

Support Groups

You can find more information and support resources at the following organizations:

·         National Osteonecrosis Foundation -- www.nonf.org

·         Avascular Necrosis / Osteonecrosis Support Group International Association -- osteonecrosisavnsupport.org

·         The Arthritis Foundation -- www.arthritis.org

Outlook (Prognosis)

How well you do depends on the following:

·         The cause of the osteonecrosis

·         Stage of the disease when it was diagnosed

·         Amount of bone involved

·         Your age and overall health

Outcome can vary from complete healing to permanent damage in the affected bone.

Possible Complications

Advanced osteonecrosis can lead to osteoarthritis and permanent decreased mobility. Severe cases may require joint replacement.

When to Contact a Medical Professional

Call your provider if you have symptoms.

Prevention

Many cases of osteonecrosis do not have a known cause, so prevention may not be possible. In some cases, you can reduce your risk by doing the following:

·         Avoid drinking excessive amounts of alcohol.

·         When possible, avoid high doses and long-term use of corticosteroids.

·         Dive safely to avoid decompression sickness.

Source: https://medlineplus.gov/ency/article/007260.htm

Contents

Causes

Symptoms

Exams and Tests

Treatment

Outlook (Prognosis)

Possible Complications

When to Contact a Medical Professional 

Prevention

Scoliosis is an abnormal curving of the spine. Your spine is your backbone. It runs straight down your back. Everyone’s spine naturally curves a bit. But people with scoliosis have a spine that curves too much. The spine might look like the letter C or S.

Abnormal curvature in the spine is known as scoliosis, and generally begins just at the onset of puberty and progresses during the period of rapid growth. Most junior high schools routinely screen for scoliosis because, if caught early, progressive spine curvature can be prevented. Scoliosis affects girls much more frequently than boys.

Causes

Most of the time, the cause of scoliosis is unknown. This is called idiopathic scoliosis. It is the most common type. It is grouped by age.

• In children age 3 and younger, it is called infantile scoliosis.
• In children age 4 through 10, it is called juvenile scoliosis.
• In children age 11 through 18, it is called adolescent scoliosis.

Scoliosis most often affects girls. Some people are more likely to have curving of the spine. Curving generally gets worse during a growth spurt.

Other types of scoliosis are:

• Congenital scoliosis: This type of scoliosis is present at birth. It occurs when the baby’s ribs or spine bones do not form properly.
• Neuromuscular scoliosis: This type is caused by a nervous system problem that affects the muscles. Problems can include cerebral palsy, muscular dystrophy, spina bifida, and polio.

Symptoms

Usually there are no symptoms.

If there are symptoms, they may include:

• Backache or low-back pain
• Tired feeling in the spine after sitting or standing for a long time
• Uneven hips or shoulders (one shoulder may be higher than the other)
• Spine curves more to one side

Exams and Tests

The health care provider will perform a physical exam. You will be asked to bend forward. This makes your spine easier to see. It may be hard to see changes in the early stages of scoliosis.

 The exam may show:

• One shoulder is higher than the other
• The pelvis is tilted

X-rays of the spine are done. X-rays are important because the actual curving of the spine may be worse than what your doctor can see during an exam.

Other tests may include:

• Spinal curve measurement (scoliometer screening)
• MRI of the spine

Treatment

Treatment depends on many things:

• The cause of scoliosis
• Where the curve is in your spine
• How big the curve is
• If your body is still growing

Most people with idiopathic scoliosis do not need treatment. But you should still be checked by a doctor about every 6 months.

If you are still growing, your doctor might recommend a back brace. A back brace prevents further curving. There are many different types of braces. What kind you get depends on the size and location of your curve. Your health care provider will pick the best one for you and show you how to use it. Back braces can be adjusted as you grow.

Back braces work best in people over age 10. Braces do not work for those with congenital or neuromuscular scoliosis. 

Sometimes, surgery is needed:

• Scoliosis surgery involves correcting the curve as much as possible.
• The spine bones are held in place with one or two metal rods. The rods are held down with hooks and screws until the bone heals together.
• Surgery may be done with a cut through the back, belly area, or beneath the ribs.

After surgery, you may need to wear a brace for a while to keep the spine still.

You may need surgery if the spine curve is severe or getting worse very quickly. The surgeon may want to wait until all your bones stop growing, but this is not always possible.

Scoliosis treatment may also include:

• Emotional support. Some children, especially teens, may be self-conscious when using a back brace.
• Physical therapy and other specialists to help explain the treatments and make sure the brace fits correctly.

Outlook (Prognosis)

How well  a person with scoliosis does depends on the type, cause, and severity of the curve. The more severe the curving, the more likely it will get worse after the child stops growing.

People with mild scoliosis do well with braces. They usually do not have long-term problems.  Back pain may be more likely when the person gets older.

Outlook for those with neuromuscular or congenital scoliosis varies. They may have another serious disorder such as cerebral palsy or muscular dystrophy, so their goals are much different. Often the goal of surgery is simply to allow a child to be able to sit upright in a wheelchair.

Congenital scoliosis is difficult to treat and usually requires many surgeries.

Possible Complications

Complications of scoliosis can include:

• Breathing problems (in severe scoliosis)
• Low back pain
• Lower self-esteem
• Persistent pain if there is wear and tear of the spine bones
• Spinal infection after surgery
• Spine or nerve damage from an uncorrected curve or spinal surgery

When to Contact a Medical Professional

Call your health care provider if you suspect your child may have scoliosis.

Prevention

Routine scoliosis screening is now done in middle schools.

Such screening has helped detect early scoliosis in many children.

Source: http://www.nlm.nih.gov/medlineplus/ency/article/001241.htm