Avascular Necrosis - Shoulder 733.41

synonyms: avascular necrosis of the humeral head, shoulder avn, shoulder osteonecrosis

Osteonecrosis of the Humeral Head ICD-9

• 733.41(shoulder) asceptic necrosis of bone-humeral head

Osteonecrosis of the Humeral Head Etiology / Epidemiology / Natural History

• Can be posttraumatic or nontraumatic.
• Postraumatic: generally after proximal humerus fracture with disruption of blood supply to humeral head
• Nontrauamtic: associated with sickle cell anemia, corticosteriod use ,

Osteonecrosis of the Humeral Head Anatomy

• Humeral Head Anatomy
• See also Shoulder anatomy.

Osteonecrosis of the Humeral Head Clinical Evaluation

Osteonecrosis of the Humeral Head Xray / Diagnositc Tests

• AP, scapular lateral and axillary views. See Shoulder Xray.

Osteonecrosis of the Humeral Head Classification / Treatment

• Cruess Classification (Cruess RL, CORR 1978;130:86)
  -Stage 1: preradiographic
  -Stage 2: mottled sclerosis
  -Stage 3: subchondral fracturing / cresent sign
  -Stage 4: collapse of subchondral bone and loss of sphericity
  -Stage 5: degenerative changes of the glenoid
• Core Decompression: (Chapman C, Arthroscopy 2004;20:1003), (Mont MA, JBJS 1993;75Br:785)
• Hemiarthroplasty
• Total Shoulder Arthroplasty: (Hattrup SJ, JSES 2000;9:177),
• Resurfacing arthroplasty: can be with bone loss up to 31% of humeral head (Raiss P. JBJBS 2009;91A:340).

Osteonecrosis of the Humeral Head Associated Injuries / Differential Diagnosis

TSA Complications

• Overall 12% incidence (Chin PY, JSES, 2006;15:19) (14%=Cofield RH, ICL 1990;39:449)
• Instability / soft tissue imbalance:
• Rotator cuff tear (Hattrup SJ, JSES, 2006;15:78)
• ectopic ossification
• glenoid loosening
• Peri-Prosthetic fracture (0.5%-3%)
• nerve injury (Lynch NM, JSES 1996;5:53)
• infection: <1% with peri-operative antibiotics
• humeral loosening
• Long-head of biceps rupture

Osteonecrosis of the Humeral Head Follow-up Care

Osteonecrosis of the Humeral Head Review References