
MRI examination: Avascular bone necrosis / osteonecrosis of the shoulder. Dr. Roberto Schubert, Radiopaedia.org. From the case rID: 16018
Contents
Definition
Avascular bone necrosis (osteonecrosis) causes bone tissue to die, most often in the end areas of bones (epiphyses), for example in the head of the femur towards the hip joints or down towards the knees. The humerus can be attacked by the shoulders. Smaller bones in the feet, hands and vertebrae can also be attacked.
- The condition is also called aseptic or ischemic bone necrosis.
Disease Causes
Avascular bone necrosis is caused by low blood supply to the skeleton in various conditions:
- Alcoholism
- Fractures
- bisphosphonates in cancer treatment (rare in osteoporosis treatment).
- Necrosis of the jawbone
- Blood disease
- Pancreatitis (pancreatitis)
- Diabetes mellitus
- Diving sickness (Caisson's disease)
- Gaucher's disease
- HIV / AIDS infection
- Chemotherapy in cancer treatment
- Cholesterol
- Histiocytosis
- Luxations ("out of joints")
- Corticosteroids (Prednisone) in high doses
- Kidney transplant
- Sickle cell anemia
- Radiation injuries in cancer treatment
- Pregnancy
- Systemic lupus erythematosus (SLE),
Among children, avascular bone necrosis occurs at different locations (see list below), most commonly at the hip Legg-Calve-Perthes disease and epiphysiolysis (epiphysiolysis capitis femoris).
Symptoms of avascular bone necrosis
Pain occurs early and is a typical symptom.
- If the limb is close to the hip joint (most common location), the pain is often felt in the groin and pelvis, especially during strain and movement

Avascular necrosis of the vertebrae (Kümmell's disease). Illustration: A.Prof Frank Gaillard, Radiopaedia.org, rID: 5354
Examinations
In early stages, the diagnosis can be difficult to set.
- MRI however, often shows distinct changes in the skeleton
- If the bone structure collapses, x-rays will also be useful, and clinical examination often shows reduced mobility
Diagnosis
Avascular bone necrosis is detected on the basis of symptoms and MRI in early stages. Later in the process, X-rays also show typical changes.
Various types of avascular bone necrosis
Own name list here
Shoulder
- Hass disease: Shoulder (humerus head)
collarbone
- Friedrich disease: Collar (medial)
Elbow
- Brailsford disease: Elbow (radius head)
- Panner disease: Elbow (humerus head)
Wrist
- Wrist (distal ulna)
Hand
- Caffey disease: hand or knee (whole hand or intercondylar on tibia)
- Dietrich disease: Hand (metacarpal heads)
- Kienbock disease: Hand (os lunatum)
- Mauclaire disease: Hand (metacarpal heads)
- Preise illness: Hand (scaphoid)
- Thiemann disease: Hands or feet (base of the falanges)
Back Whirls
- Kümmell disease: Vertebra
Hip
- Epiphysiolysis in children (epiphysiolysis capitis femoris)
- Add-Calvé-Perthes disease: in children, hip (thigh bone head)
- More here (Wikipedia)
Pelvic
- From Neck-Odelberg disease: Pelvic (ischiopubic synchondrosis)
Knee
- Ahlback disease: knee (medial femur condyl, ie SONK)
- Caffey disease: hand or knee (whole hand or intercondylar on tibia)
- Kohler disease: Knee or foot in children (patella or os navicularis
Ankle
- Dias disease: foot (trochlea at talus)
- Liffert-Arkin Disease: Ankle (distal tibia)
Foot
- Freiberg disease: Foot (head to 2 metatars)
- Iselin Disease: Foot (base of 5 metatars)
- Mueller-Weiss disease: Foot in adults (os navicularis)
- Sever disease: Foot, heel (calcaneus epiphysis)
- Thiemann disease: Hands or feet (base of falcons)
Incorrect diagnosis (similar conditions, differential diagnoses)
- Arthritis / joint disease
- Osteoarthritis
- CRMO (child)
- Osteomyelitis (infection)
- Tumor (benign or cancerous)
Treatment
In the early stages it is recommended to relieve the affected area for example by using crutches and using painkillers or NSAIDs as required. Most people will still need surgery afterwards
- In case of major joint injuries in the hips, knees or shoulders, insertion of a joint prosthesis is often chosen
Literature
- Gupta M, 2019 (Bisphosphonates and Jaw Erosis)
- Baig SA, 2018 (hip)
- Grans Compendium in Rheumatology