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Dr. German
Dr. German, Doctor (MD)
Category: Health
Satisfied Customers: 3806
Experience:  MD
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i had an mri done on both shoulders. They both indicate AVN

Resolved Question:

i had an mri done on both shoulders. They both indicate AVN of the humeral head. The left also indicates a full thickness tear of posterior supraspinatus/anterior infrapinatus measures 5mm of medial lateral 6mm anteroposterior.

My question is this, what treatment is most effective for AVN and is fixing rotator cuff even relevant due to the avn?
Submitted: 11 months ago.
Category: Health
Expert:  Dr. German replied 11 months ago.

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 !

 

 

 

Please leave a positive feedback ( click on excellent or good service ) if you are satisfied with my answer.

Customer: replied 11 months ago.

Hi and thank you for your reply. I have a long history of large amounts of steriods, I had a tracheoplasty in 2007 and had subsequent exacerbations of asthma, also have an ideopathic clotting disorder and have had multiple clots. so i am sure those events have led to this.


 


Is replacing the head in essence a partial shoulder replacement?


I had a revision of a partial knee to tka in march. due to hardware failure could AVN have contributed to the failure?


 


How will I know if other joints are also going to have this, or do I have to wait till symptoms to appear.


 


How long is recovery for the procedures you mentioned?


 

Expert:  Dr. German replied 11 months ago.
When they replace the humerus head , they are doing a total replacement where they replace the head of the humerus bone and the shoulder joint socket ,this is not a partial replacement .

Yes , the AVN could have contributed to the failure , it is impossible to tell you if other joints will be affected in the future or not . With your condition , it is always a possibility . The most important thing is to manage all the triggering factors from steroid overuse ,clotting disorders or other underlying factors . In that way , your personal risk of developing new complications will potentially decrease .

The recovery time is usually from 3-6 months.



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 !



Please leave a positive feedback ( click on excellent or good service ) if you are satisfied with my answer.


Dr. German, Doctor (MD)
Category: Health
Satisfied Customers: 3806
Experience: MD
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