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Osteonecrosis of the Humeral Head M87.029 733.41

 
ICD-9 Classification / Treatment
Etiology / Natural History Associated Injuries / Differential Diagnosis
Anatomy Complications
Clinical Evaluation Follow-up Care
Xray / Diagnositc Tests Review References

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

 

Osteonecrosis of the Humeral Head ICD-10

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

Osteonecrosis of the Humeral Head Clinical Evaluation

  • Gradually progressive shoulder pain.
  • Progessive stiffness and loss of motion.
  • Generally normal strength

Osteonecrosis of the Humeral Head Xray / Diagnositc Tests

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