Symptoms tend to be nonspecific. Avascular necrosis of the femoral head presents as groin pain that intermittently radiates down the anteromedial thigh. Patients may demonstrate an antalgic gait, gluteus minimus limp, or limited range of motion, especially in flexion, abduction, and internal rotation, with a distinct click elicited by external rotation of the flexed abducted hip, particularly when moving from a sitting position. Avascular necrosis of the humeral head may long go undetected because the shoulder is not a weight-bearing joint and symptoms may be transient or mild. Pain commonly radiates to the deltoid tuberosity of the humerus.
Active motion is limited very early, but passive motion is preserved.
Avascular necrosis of the humeral head without other sites of involvement is rare. Diagnosis Early diagnosis requires a high index of suspicion in patients presenting with pain, particularly of the hips, knees, or shoulders. Diagnostic testing depends on the stage of the disease. MRI is the most sensitive and specific technique and should be used for very early diagnosis, when collapse of the femoral head or other bone may be preventable. If duration of disease is not clear, an x-ray or CT scan should be obtained to rule out advanced disease.