Shoulder Osteonecrosis
| ICD-9 |
Classification / Treatment |
| Etiology / Epidemiology / Natural History |
Associated Injuries / Differential Diagnosis |
| Anatomy |
Complications |
| Clinical Evaluation |
Follow-up Care |
| Xray / Diagnositc Tests |
Review References |
synonyms: osteonecrosis, ON, asceptic necrosis, avascular necrosis of the humeral head, AVN
ICD-9
- 715.21 (osteoarthrosis, localized, secondary, shoulder region)
- 716.81 (other unspecified arthropathy, shoulder region)
- 733.4 (asceptic necrosis of bone)
Etiology / Epidemiology / Natural History
- Uncommon.
- Humeral head is second most common site for AVN (1st=femoral head).
- Risk factors: steroid use, sickle cell disease, trauma, Gaucher's disease, caisson disease, prior radiation, alcoholism.
- Natural history: Necrosis of subchondral bone > micro fractures > humeral head collapse > glenoid cartilage loss > progressive arthritis. Necrotic area may become revascularized before collapse and disease not progress.
Anatomy
- Most common location is the superocentral humeral head (articulates with glenoid in 90° of abduction
Clinical Evaluation
- Initially patients may have pain only with activity. Advanced disease shows increased pain, loss of active and passive motion, functional limitaions.
Xray / Diagnositc Tests
- AP, scapular lateral and axillary views
- Bone scan may show increased or decreased signal
- MRI shows decreased marrow signal intensity on T1 images. Higher sensitivity and specificity than bone scan.
Classification / Treatment
- Stage I: xrays normal, bone scan/ mri abnormal
- Stage II: Osteoporosis, osteosclerosis on xray
- Stage III: Crescent sign (subchondral radiolucent line).
- Stage IV: extensive collapse of subchondral bone, severe articular incongruity, progessive DJD.
- Stage V: pathologic changes in glenoid as well.
Associated Injuries / Differential Diagnosis
Complications
Follow-up Care
Review References
|
