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Rapid destruction of the humeral head caused by subchondral insufficiency fracture: a report of two cases.

Goshima K, Kitaoka K, Nakase J, Tsuchiya H - Case Rep Orthop (2015)

Bottom Line: Magnetic resonance imaging showed a bone marrow edema pattern with an associated subchondral low-intensity band, typical of SIF.Shoulder RDA occurs as a result of SIF in elderly women; the progression of the joint destruction is more rapid in cases with SIFs of both the humeral head and the glenoid.Although shoulder RDA is rare, this disease should be included in the differential diagnosis of acute onset shoulder pain in elderly female patients with osteoporosis and persistent joint effusion.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Toyama Municipal Hospital, 2-1 Imaizumi Hokubu-machi, Toyama 939-8511, Japan.

ABSTRACT
Rapidly destructive arthritis (RDA) of the shoulder is a rare disease. Here, we report two cases, with different destruction patterns, which were most probably due to subchondral insufficiency fractures (SIFs). Case 1 involved a 77-year-old woman with right shoulder pain. Rapid destruction of both the humeral head and glenoid was seen within 1 month of the onset of shoulder pain. We diagnosed shoulder RDA and performed a hemiarthroplasty. Case 2 involved a 74-year-old woman with left shoulder pain. Humeral head collapse was seen within 5 months of pain onset, without glenoid destruction. Magnetic resonance imaging showed a bone marrow edema pattern with an associated subchondral low-intensity band, typical of SIF. Total shoulder arthroplasty was performed in this case. Shoulder RDA occurs as a result of SIF in elderly women; the progression of the joint destruction is more rapid in cases with SIFs of both the humeral head and the glenoid. Although shoulder RDA is rare, this disease should be included in the differential diagnosis of acute onset shoulder pain in elderly female patients with osteoporosis and persistent joint effusion.

No MeSH data available.


Related in: MedlinePlus

Case  1. Serial preoperative radiographs. (a) At the first visit, the humeral head shows a minor collapse. (b) Three weeks later, the collapse of the humeral head has progressed. (c) Four months later, the destruction of the shoulder is further progressed, including the glenoid.
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fig1: Case  1. Serial preoperative radiographs. (a) At the first visit, the humeral head shows a minor collapse. (b) Three weeks later, the collapse of the humeral head has progressed. (c) Four months later, the destruction of the shoulder is further progressed, including the glenoid.

Mentions: At the patient's first visit, standard radiographs demonstrated some collapse of the humeral head (Figure 1(a)) and had progressed during the following 3 weeks (Figure 1(b)). Radiographs taken 4 months later also revealed destruction of the glenoid (Figure 1(c)). Computed tomography (CT) indicated a destroyed humeral head, displaced bony fragments outside of the greater tuberosity, and destruction of the glenoid (Figure 2(a)). Magnetic resonance imaging (MRI) revealed joint effusion in the glenohumeral joint and a rotator cuff tear, but tumor masses and synovial hyperplasia were not observed (Figure 2(b)).


Rapid destruction of the humeral head caused by subchondral insufficiency fracture: a report of two cases.

Goshima K, Kitaoka K, Nakase J, Tsuchiya H - Case Rep Orthop (2015)

Case  1. Serial preoperative radiographs. (a) At the first visit, the humeral head shows a minor collapse. (b) Three weeks later, the collapse of the humeral head has progressed. (c) Four months later, the destruction of the shoulder is further progressed, including the glenoid.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4402478&req=5

fig1: Case  1. Serial preoperative radiographs. (a) At the first visit, the humeral head shows a minor collapse. (b) Three weeks later, the collapse of the humeral head has progressed. (c) Four months later, the destruction of the shoulder is further progressed, including the glenoid.
Mentions: At the patient's first visit, standard radiographs demonstrated some collapse of the humeral head (Figure 1(a)) and had progressed during the following 3 weeks (Figure 1(b)). Radiographs taken 4 months later also revealed destruction of the glenoid (Figure 1(c)). Computed tomography (CT) indicated a destroyed humeral head, displaced bony fragments outside of the greater tuberosity, and destruction of the glenoid (Figure 2(a)). Magnetic resonance imaging (MRI) revealed joint effusion in the glenohumeral joint and a rotator cuff tear, but tumor masses and synovial hyperplasia were not observed (Figure 2(b)).

Bottom Line: Magnetic resonance imaging showed a bone marrow edema pattern with an associated subchondral low-intensity band, typical of SIF.Shoulder RDA occurs as a result of SIF in elderly women; the progression of the joint destruction is more rapid in cases with SIFs of both the humeral head and the glenoid.Although shoulder RDA is rare, this disease should be included in the differential diagnosis of acute onset shoulder pain in elderly female patients with osteoporosis and persistent joint effusion.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Toyama Municipal Hospital, 2-1 Imaizumi Hokubu-machi, Toyama 939-8511, Japan.

ABSTRACT
Rapidly destructive arthritis (RDA) of the shoulder is a rare disease. Here, we report two cases, with different destruction patterns, which were most probably due to subchondral insufficiency fractures (SIFs). Case 1 involved a 77-year-old woman with right shoulder pain. Rapid destruction of both the humeral head and glenoid was seen within 1 month of the onset of shoulder pain. We diagnosed shoulder RDA and performed a hemiarthroplasty. Case 2 involved a 74-year-old woman with left shoulder pain. Humeral head collapse was seen within 5 months of pain onset, without glenoid destruction. Magnetic resonance imaging showed a bone marrow edema pattern with an associated subchondral low-intensity band, typical of SIF. Total shoulder arthroplasty was performed in this case. Shoulder RDA occurs as a result of SIF in elderly women; the progression of the joint destruction is more rapid in cases with SIFs of both the humeral head and the glenoid. Although shoulder RDA is rare, this disease should be included in the differential diagnosis of acute onset shoulder pain in elderly female patients with osteoporosis and persistent joint effusion.

No MeSH data available.


Related in: MedlinePlus