Welcome and thanks for your question I am Dr. German I would be here to help you and give you assistance until you are satisfied, in your case , it would be important to repair the AVN damage on the humeral heads before repairing the tears in the rotator cuff muscles .
Your doctor will need to :
1- Find out what factors are affecting you and have produced the necrosis , there are several conditions that can produce necrosis like sickle cell disease, trauma , autoimmune disorders like rheumatoid arthritis or lupus , steroid use , osteoporosis, alcohol , smoking or decreased blood flow ( associated to the high cholesterol blood levels ) . These factors need to be managed to decrease your risk of developing further complications .
2- The treatment could include replacing the humeral heads or placing a graft if your doctor considers it necessary . In most cases , doctors perform both procedures ,they place a bone metal or plastic prosthesis , they remove any bony fragment,decompress the area to restore blood flow and nerve function and suture the torn tendon ,reattaching it . If the tissue is extremely deteriorated , they also place a mesh to reinforce the area.
3-You should receive physical therapy so you can recover the mobility of your shoulders and avoid future stiffness problems .
4- All this will be combined with additional measures , including taking anti-inflammatory medication , electrotherapy that promotes bone growth , a sling but only for a short period of time , in some cases steroid injections and medications like alendronate ( which inhibits bone resorption ) , cholesterol lowering medications ( if your cholesterol blood levels are increased ) or clot dissolving medication like warfarin if you have a blood clotting disorder which could decrease your bone tissue blood flow, producing future bone loss or affect the bone regrowth process.
If you need any additional information I will be happy to continue further and assist you until you are completely satisfied . Good luck to you and have a good day !
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