Avascular Necrosis (AVN)

Avascular necrosis (AVN) is a condition that affects the ball portion of the shoulder joint when there is a lack of blood flow to the bone. Lack of blood flow can cause the bone to die which can cause severe pain and even lead to collapse of the ball portion of the shoulder joint.

Risk Factors

  • Risk factors include excessive alcohol use, use of steroid medication, blood disorders (sickel cell anemia, thalassemia, etc...), trauma, and exposure to changes in atmospheric pressures (divers).


  • Presenting signs and symptoms include pain at rest, pain with motion of the shoulder, and loss of motion and function of the shoulder.


  • Treatment is aimed at controlling the symptoms of pain and trying to maintain the roundness of the ball of the shoulder joint. Medications for pain (tylenol, anti-inflammatory medications, selective pain medications), avoiding painful activities, and alternative treatment options (electrical stimulations, ultrasound) are conservative treatment options.

Surgical Options

  • Surgical options depend on the stage of the process and can include removal the dead bone of the shoulder (core decompression), increasing the blood flow to the area of dead bone (vascularized grafts), or partial/total shoulder replacement for severely damaged and irregular ball portion of the shoulder joint.