History

AVN may present with nonspecific signs and symptoms.

Early in the disease process, the condition is painless; however, patients ultimately present with pain and limitation of motion.

The pain is most commonly localized to the groin area, but it may also manifest in the ipsilateral buttock, knee, or greater trochanteric region.

Painful symptoms are usually exacerbated with weight bearing but are relieved by rest.

Physical Examination

Passive range of motion of the hip is limited and painful, especially forced internal rotation.

A distinct limitation of passive abduction is usually noted.

A straight-leg raise against resistance provokes pain in most symptomatic cases.

Passive internal and external rotation of the extended leg ("log roll test") may elicit pain that is consistent with an active capsular synovitis.

Differential Diagnoses

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Author

John D Kelly, IV, MD Associate Professor, Department of Orthopedic Surgery, University of Pennsylvania, Attending Surgeon Pennsylvania Hospital, Veterans Adminsitration Hospital

John D Kelly, IV, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, Eastern Orthopaedic Association, Pennsylvania Orthopaedic Society, Philadelphia County Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

David Wald, DO, FACOEP Assistant Program Director, Assistant Professor, Department of Medicine, Division of Emergency Medicine, Temple University School of Medicine

David Wald, DO, FACOEP is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

Additional Contributors

Gerard A Malanga, MD † Founder and Partner, New Jersey Sports Medicine, LLC and New Jersey Regenerative Institute; Director of Research, Atlantic Health; Clinical Professor, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey-New Jersey Medical School; Fellow, American College of Sports Medicine

Gerard A Malanga, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Institute of Ultrasound in Medicine, International Spine Intervention Society, North American Spine Society

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Lipogems.

Sections Femoral Head Avascular Necrosis
Overview
Presentation
DDx
Workup
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Femoral Head Avascular Necrosis Clinical Presentation

History

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