09-19-2004, 06:12 PM
:oops: Kind of a strange pain I haven't had before. In my left armpit. It throbs and hurts sometimes really badly. It seems to hurt most when I am driving or typing things of that nature. I haven't been able to find anything to deal with the pain. My normal pain meds don't seem to be helping much. Sometimes if I bend my arm at the elbow and push my whole arm up to the as far as I can push it, it relieves the preassure and some of the discomfort. Anyone have any idea what this might be or ever have anything like this :?: Thanks ahead of time. ~Lucy
09-23-2004, 09:09 AM
HMMMM???? Is there just pain or do you feel soreness and/or any type of lump? I mean, it may be a boil that is just beginning. I have had those many times in my armpits and it always starts out as very painful!!
Otherwise, you may need to point it out to your doctor if the pain persists!!
09-23-2004, 09:21 AM
I went to the doctors. Yesterday, because the pain just keeps getting worse. In fact typing makes it hurt worse. She is very worried that it is something called avascular necrosis of the shoulder. I have only breifly looked it up on the internet. Seems like it means the bone is dying? I don't know. I have to wait till next week to have an MRI to dx what's really happening there. It also could be some sort of arthiritis. Or just as simple as a rotater cuff tear? But, she is very worried since I have been on so many years of steriods and at such very high high doses. Also, people with lupus seem to also have a higher chance of devloping this disorder. I hate waiting to find out what it is. especially since if it is avascular necrosis I will need a full shoulder replacement. Alot to think about. Alot to worry about. Anyway, that's the update. ~Lucy :?
09-24-2004, 01:54 AM
Lucy; Here is what I was able to find out about Avascular Necrosis. 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.
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 have found that long-term, systemic (oral or intravenous) corticosteroid use is associated with 35 percent of all cases of nontraumatic avascular necrosis. Your doctor is very wise to consider this condition in light of the fact that you have had long term use of steroids.
Doctors aren't sure exactly why the use of corticosteroids can sometimes leads to avascular necrosis. They believe that corticosteroids 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. Corticosteroid-related avascular necrosis is often more severe and more likely to affect both hips (when occurring in the hip) than avascular necrosis resulting from other causes. 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.
To correctly diagnose avascular necrosis, your doctor may use one or more imaging techniques. Early diagnosis increases the chances of your treatment being successful.
Your doctor may first recommend an x ray to help identify the cause of your pain and to see if the pain is caused by a fracture or arthritis. If the x ray is normal, you may need to have more tests such as a magnetic resonance imaging, or MRI. This test is the most sensitive method for diagnosing avascular necrosis in the early stages. Then, the following tests may be used after the X-Ray and the MRI to determine the amount of bone affected and how far the disease has progressed.
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 you to more radiation. Bone scans do not detect avascular necrosis at the earliest stages.
A CT scan is an imaging technique that provides the doctor with a three-dimensional picture of your 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.
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 you have 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.
Appropriate treatment for avascular necrosis is necessary to keep your joints from breaking down. If untreated, you 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 your pain. To determine the most appropriate treatment, your doctor will have to consider the following aspects: Your age:
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 use of the affected joint, to stop further damage to your bone, and to ensure your bone and joint survival. In order to reach these goals, your doctor may use one or more of the following treatments.
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, your doctor may begin treatment by having you remove weight from the affected joint. Your doctor may recommend that you limit activities or use a sling for your arm. 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.
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 your body, 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.
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 your doctor will know about them.
For most people with avascular necrosis, treatment is an ongoing process. Your doctor may first recommend the least complex and least invasive procedure, such as protecting the joint by limiting movement, and watch the effect on your condition. Other treatments then may be used to prevent further bone destruction and reduce pain. It is important that you carefully follow your doctor's instructions about activity limitations and work closely with your doctor to ensure that appropriate treatments are used.
Here is a good resource to learn more about avascular necrosis:
National Institute of Arthritis and Musculoskeletal
and Skin Diseases Information Clearinghouse
National Institutes of Health
1 AMS Circle
Bethesda, MD 20892-3675
Phone: 301-495-4484 or
877-22-NIAMS (226-4267) (free of charge)
I hope that this information has been helpful to you. Keep us posted and I wish you the very best!
Peace and Blessings