There is also an idiopathic avascular necrosis at the knee occurring most often in elderly women. For other patients, the initial insult is asymptomatic. Such pain is induced by standing, walking, moving, coughing, or other mechanical stress and is largely relieved by rest. Patients with advanced disease have pain at rest. In fracture patients, symptoms that may indicate avascular necrosis are increased pain and limp at about 1-yr postevent.
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.