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Any tips on pain management for avascular necrosis?

I was diagnosed with stage 2 kienbocks disease december of 2019. Since I am still in an early stage of the disease my doctor performed core decompression of the distal radius in attempts to slow progression of the disease. He also repaired a torn tfcc during the surgery. I've recovered from the surgery and my pain levels are now more tolerable however when sleeping at night I find that my wrist pain often flares up. Any tips for managing this kind of pain at night?
2 Responses
973741 tn?1342342773
Wow, you've been through a lot.  Do you try to sleep with the hand propped up a bit or elevated?  I believe that is the recommendation, to be above the heart especially.  Get some pillows beside you and sleep on your side if able to do this elevation.  Are you taking pain medication even nsaids?  Nighttime would be good for that to help.  Also, perhaps ice before bed would help set you up for the night too. The other thing that they often suggest is 'gentle motion'.  Have they given you some movements to do to stretch and move it a bit? You could keep your ibuprofen or acetaminophen right by your bed in case you wake at night uncomfortable and need to take some to get back to sleep.  

I've also read that avascular necrosis pain can become worse at night.  Ugh.  They may recommend nsaids at night for that too. Do they have you working with a physical therapist?
Avatar universal
As far as night pain, I do not like taking anything but have found that propping elbow between pillows to keep arm raised up helps.  I was not diagnosed with Kienbocks until my hand doctor did arthroscopic.  I am a 62 year old healthy female that never had that "ah ha" moment that I did anything but I am quite active. I woke up one night literally crying in pain.  After a month of not being able to deal with it, saw ortho and got cortisone shot which helped somewhat.  Had MRI but no one mentioned dead tissue.  I was told it was synovitis.  Ortho sent me to hand specialist that basically said same thing and scheduled arthroscopic as I insisted I could not continue like this (and I have a very good pain tolerance).  He debrided a fairly large flap central tear.  Then noticed significant loose cartilage along ulnar and central aspects of the lunate, which was debrided and found bone beneath very spongy and not normal subchondral bone.  he shave to smooth surface to a stable edge.  As he put it to my husband "I found pieces of bone and cartilage floating around where it shouldn't have been".  He said he would have to discuss with colleagues as he had not seen this before. Bandages off today and PA told me I have Kienbocks. After reading every thing I can on it, I had all the classic signs but I guess since not a common disease, they didn't know what it was.  Still some swelling of course  and pain (feels like burning),  told to do exercises to regain ROM.  I opted not to do PT at docs office as I feel I can do these at home and it would be a 2 hour round trip.  From what I have been reading, it sounds like this never goes away.  I was given the impression that they fixed it.  Now I guess I just wait to see if the pain comes back?  
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