Avascular Necrosis, also termed as Ischemic Bone Necrosis or Osteonecrosis is a medical condition characterized by the bone death on being deprived of blood. The condition is known to occur in the shoulder, ankles, and knees. However, the part of the body most affected by Avascular Necrosis is the hip. In this article, we will describe the conditions that contribute towards Avascular Necrosis of the hip along with the associated symptoms.

Factors that lead to Avascular Necrosis of the hip
The supply of blood to the bones may be interrupted by a myriad of factors some of which include

1. Certain medical conditions and health disorders such as

Gaucher's disease: A genetic disorder resulting from glucocerebrosidase enzyme deficiency. As a result, glucocerebroside gets deposited in the cells of the macrophage-monocyte system.
Sickle cell anemia: A genetic disorder which results in the RBC's appearing like a sickle cell instead of being round shaped.
Both of these conditions bring about a significant reduction in the supply of blood to the bones resulting in Avascular Necrosis.

Certain inflammatory conditions that may damage the arteries and trigger Avascular Necrosis of the hip include autoimmune diseases, pancreatitis or HIV infection.

2. Extensive and prolonged use of corticosteroids: Often used as non-inflammatory drugs, corticosteroids can play a contributing role, resulting in Avascular Necrosis (non-traumatic). The fatty substances are usually broken down by the body. However, the use of corticosteroids may affect this breakdown as a result of which the fatty substances start piling up in the blood vessels, constricting their size. The constricted blood vessels, in turn, reduces the supply of blood to the bones to a great extent.

3. An injury or a fracture affecting the femur: A hip fracture or a dislocation that affects the upper half of the thigh bone or the femur acts as a potential threat, triggering a traumatic Avascular Necrosis (AVN) of the hip.

In some case, radiation therapy or chemotherapy for cancer can go a long way in interfering with the ability of the bone (weakens the bone) to receive blood, causing bone death.

People who are into heavy drinking stand a greater risk of suffering from AVN. An increased consumption of alcohol causing constriction and narrowing of the blood vessels interfering with the flow of blood to the bones.

Symptoms characteristic of AVN of the hip

Unfortunately, the initial stages of AVN are asymptomatic. However, as the condition progresses into later stages, a person may experience pain and discomfort, particularly while exerting pressure on the bone affected by the condition.
As the bone and the adjacent joints deteriorate and collapse further, a person may experience great difficulty in using the joint altogether.
In some cases, the condition may progress and affect both the hips (Avascular Necrosis Bilateral).

Causes and Symptoms of Avascular Necrosis of the Hip

Oh my aching Heel!! The combination of foot and ankle consists of 26 bones, 33 joints and an excess of 100 tendons. The longest bone present in the foot is the heel. Over usage or injury to the heel would lead you to experience pain in the heels. The severity of the heal pain can range from mild to excruciating. 

The cause behind heel pain is typically associated with excess usage of the heel bone. Straining of your heel occurs if you excessively pound your feet on surfaces that are hard, or you are overweight or even if you wear shoes that do not fit your feet properly. These strains cause irritation in the muscles, bones or tendons that are present in the heels. Some of the other common causes include: 

Heel Spurs: Development of heel spurs occurs due to the continuous stretching of the lining, which covers the heel. Upon continuous stretching, pieces of the lining tend to break off. Development of heel spurs is common in athletes who frequently jog or run. People who are obese also tend to experience pain due to heel spurs. 
Plantar Fasciitis: Development of Plantar Fasciitis occurs due to the inflammation of the tendinous tissue that connects the heel to the ball of the foot. Development of Plantar Fasciitis is common in athletes who frequently jog or run as well as people who wear shoes that don?t fit the feet properly. It may occasionally be associated with Vitamin B12 deficiency and raised uric acid in blood 
Achilles Tendinitis: This is the inflammation of the Achilles tendon. Achilles Tendinitis occurs commonly in people who have active lifestyles, such as people who are joggers, runners or even dancers. 
Treatment-

Physical therapy, medication or alternative treatments can be used to treat this form of pain. Medications for heel pain can only be in the form of anti-inflammatory drugs. Although these oral medications cannot significantly relieve heel pain, some injections containing substances such as corticosteroids, as well as Arthrocentesis (removal of fluid present in joints using hollow needles) might be able to provide relief. Recently PRP (Platelet Rich Plasma) injection have been found very useful in treating recalcitrant Plantar fasciitis and heel pains. 

Common practices that can be used to relieve discomfort include: 

Application of ice to the heel for a duration of 15 minutes daily. 
Utilize over-the-counter pain medications .
Have adequate amounts of rest .
Wear shoes that fit properly .
Walking on tip toes to stretch the plantar fascia helps to relieve heel pain.

Heel Pain: Know its Causes and Treatments

6 Bodily Pains You Must Never Ignore

Any pain in the body is an indication and demands attention. Some pains go away by themselves or by home treatment, while few need medical attention. 

Here are 6 types of pains which should never be ignored.

Chest Pain - Chest pain that doesn't go away and is accompanied by shortness of breath can prove to be fatal if not treated at the earliest. Do not wait for it to subside, nor should you try self medication. Consult the doctor immediately.
Abdominal Pain - While abdominal pain could be because of various smaller reasons, if it is unbearable, consult a doctor at the earliest. This pain could be because of ruptured appendix, stomach ulcer, problems in your pancreas or gallbladder or even intestinal blockages.
Severe Headache - Normally we tend to take headaches lightly, believing that all we need to do is pop a medicine or rest it out. However, if the pain is excruciating, consult the doctor as soon as possible.
Prolonged Backache - If you are experiencing pain in the back with tingling in your toes, this could be associated with your discs. Give it medical attention at the earliest, as it could turn fatal.
Lower Abdomen  - Appendicitis' indicator is sharp pain on the side. If you feel a sharp pain in your lower abdomen on the right side along with symptoms like nausea, vomiting, fever, shaking, constipation and diarrhea, reach out for medical assistance as soon as possible.
Leg Pain - Yet another pain one should not ignore is deep vein thrombosis which is blood clots in the legs? deep veins.

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6 Bodily Pains You Must Never Ever Ignore

Vertebroplasty means shaping the backbone i.e. vertebra for backbone and plasty is related to shape. This is an outpatient procedure done to treat compression fractures of the spinal cord. The backbone is made up of multiple small bones which are stacked one on top of the other with a filling material in between that is known as vertebrae. The stack of bones are held in place by the soft, elastic vertebral material. 

Vertebroplasty & similar procedure called kyphoplasty is a non-surgical procedure where collapsed vertebrae is brought back to shape by injecting medical bone cement under fluroscopy / image intensifier in OT, thereby relieving pressure on the spinal cord or spinal nerves with special canula directed to the core of vertebral body. Indicated in osteoporotic vertebrae, spinal fracture, metastatic tumour or primary tumour of spine. This technique has replaced major surgery done earlier to reshape & fix vertabrae.

Technique: Bone cement, in a semisolid state, is injected into the weakened or fractured bone space. Once this solidifies, it provides additional support to the spine, enabling normal movement. It also helps in reducing the pain significantly and improves the overall mobility.

Procedure:

In what takes about an hour, the following steps are done. Earlier, a few decades ago, this would be an open surgical procedure. However, with advance technology, now it is done using a small incision

Local anesthesia is given in the area that needs to be operated
A biopsy needle is inserted into the fractured space with the help of an X-ray
The acrylic bone cement is injected into the bone space with a needle to fill up the space, once it solidifies, it stabilizes the vertebral space
The needle is removed and the incision is covered with a bandage
Usually the patient is sent home in an hour s time unless the overall condition is really bad
There could be some soreness at the site where injection is given, but one can notice a significant reduction in pain from the day of the procedure
There is also improvement in mobility while doing daily chores
The pain relief can last up to 3 years after the procedure
Returning back to normal activities takes about 3 to 4 days after the procedure
When to use this procedure?

Vertebroplasty is usually done in case of non-radicular pain that is intractable. In most cases, they do not respond to traditional therapies including physiotherapy, pain medications and even surgery. The pain could be due to:

Osteoporosis
Cancer metastasis
Myeloma
Spinal hemangiomas
Traumatic fractures
Benefits of using vertebroplasty for managing pain 

Minimally invasive
Effective way to get relief
Improves mobility
Cost-effective
Reduces need for long-term use of painkillers
Stabilizes the spine and prevents further collapse

Vertebroplasty - How It Can Help Manage Pain?

Conventional medicine treats pain with the help of medications; by either blocking the transmission of pain signals in the body or by correcting the underlying problems caused by the pain in the first place. However, traditional and alternative forms of medicine such as acupuncture manage pain issues within the body through the means of redirecting disrupted energy flows. One of the very few forms of alternative treatments used in conjunction with conventional treatments, acupuncture is seen as a mercurial rise in popularity in the past few decades.


What is acupuncture?
Acupuncture dates back to ancient China, about 2500 years ago. It has been widely practiced there for a number of millennia, not only pain relief, but also for treating many ailments. Acupuncture isn t just considered a form of therapy, but a holistic form of medicine. Acupuncture works on the principle of the flow of energy within the body, also known as  Qi , in traditional Chinese medicine. Acupuncture strives to correct the disruptions in  Qi  that may cause pain by manipulating over 2000 of the specific pressure points within the body with the help of specially created needles.


Where is acupuncture effective?
Acupuncture is very effective in treating a host of ailments, especially in relieving the associated pain. Some of the areas where acupuncture has proven its effectiveness are:
1. Treating nausea and vomiting caused due to chemotherapy treatment for cancer patients
2.  Very useful in treating post-operative pain caused due to dental procedures
3.  Rehabilitating patients who have suffered strokes
4.  Fibromyalgia (musculo-skeletal pain with fatigue accompanied by sleep and memory issues) 
5.  Effective in combating withdrawal symptoms caused due to addiction
6.  Pain from menstrual cramps
7.  Tennis elbow
8.  Osteoarthritis (a type of arthritis caused due to the erosion of tissues present at the ends of one s bones)
9.  Pain of the lower vertebrae within the spinal column
10. Asthma


How does acupuncture work within the body?
According to modern medicine, the specific pressure points utilized by acupuncture within the body help in releasing chemicals that can block or at least reduce pain. It encourages the flow of chemicals from the brain, which act as nerve and pain blockers. It also helps stimulate the muscles and nerve endings, which can lessen inflammation and thus help in reducing pain.

Acupuncture - Why Should You Use it to Combat Pain?

Leg bypass surgery is needed when the patient suffers from peripheral artery disease. PAD is a very common condition in elderly people, where the rate of flow of blood to the limbs (in this case, the legs) is reduced due to narrowing of the blood vessels.

Causes and risk factors-

The narrowing of the blood vessels occurs due to excess calcium accumulation and fat deposits in the walls of the arteries. The following are the risk factors of PAD-

  Age (60 years and above)
  Smoking
  Diabetes

The condition may be life-long or can last for years.

Symptoms that indicate you might need a leg bypass surgery-

The following are the signs and symptoms of PAD, which suggest you should consider having a leg bypass surgery-

  Pain in the legs, especially when walking
  Pain in the buttocks
  A sore on a foot/leg that does not seem to heal
  Thinning of the skin on the legs
  Loss of hair on the legs
  Tingling, weakness, or numbness in the legs
  One or both the feet/legs may feel cold
  The feet or legs may appear bluish, pale, or dark reddish in colour

You should get yourself checked by a specialist in the initial stage, or else the condition may get worse and affect your day-to-day activities.

Vascular surgery for PAD in the legs:

Vascular surgery is a surgical sub-specialty, which manages vascular system disorders- disorders of the veins, arteries, and lymphatic circulation- by surgical reconstructions, minimally invasive procedures, and medical therapies.

The most commonly used surgical procedure is the leg bypass surgery. The surgery aims to reroute the supply of blood around an obstructed artery in one of the legs.

How is leg bypass surgery performed?

The surgeon performs leg bypass surgery using a graft (usually made of plastic tube) to bypass or replace the blocked portion of the artery. On some occasions, the graft may be a vein or blood vessel taken from the patient s body (usually, the other leg).

During the surgery, the surgeon will first administer anaesthesia so that you are not able to feel pain or discomfort. He/she will make an incision over the portion of the blocked artery. After carefully removing the skin tissues, the surgeon will place clamps on each side of the narrowed artery and sew the grafts in place. The surgeon will ensure that the flow of blood in your lower extremity (legs) is good. An arteriogram (an X-ray of the arteries/blood vessels) is recommended to make sure that the graft is working fine after the leg bypass surgery.

For most people, leg bypass surgery helps improve the flow of blood in the arteries. The prognosis is better if underlying medical conditions like diabetes are controlled.

Leg Bypass - Treating It Through Vascular Surgery!

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