Ortho

7/23/99

Asceptic Necrosis

• Osteonecrosis (bone death) caused by vascular insult, usually at the end of the bone.  In adults, the most common symptom producing aseptic necrosis occurs in the femoral head (avascular necrosis).  In children, aseptic necrosis is called epiphyseal ischemic necrosis or epiphyseal aseptic necrosis.  The precise pathologic condition of these ds is debatable; therefore, the term is used here in reference to epiphyseal osteochondritis or by area:
• Assmann:  head of first metatarsal
• Buchman:  medial cuneiform
• Freiberg: 2^nd metatarsal head
• Iselins:  base of the fifth metatarsal
• Kappis: talus
• Kienbock:  lunate bone of wrist
• Kohler:  tarsal navicualr; sometimes of the patella
• Lance: cuboid
• Legg-Calve Perthes: femoral head;
• Panner: capitellum of the humerus
• Silverskjoid: calcaneus
• Theimann: proximal phalanges
• Wagner: base of the first metatarsal

Fibromyalgia

• Diffuse ms pain
• Multiple tender points
• Not a 1° inflammatory disorder
• No single treatment is curative
• Adjustments, exercises
• 3-6 million Dx
• female 20-50 y/o
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