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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  2. Magnetic resonance image (MRI) of the left shoulder at symptom onset (a, b) and at the first visit to our hospital (c). (a) T2-weighted MRI (oblique coronal plane) demonstrates joint effusion and a slightly collapsed humeral head. (b) Axial, T1-weighted MRI shows a subchondral serpiginous pattern of low signal intensity with associated bone marrow edema. (c) T2-weighted MRI (coronal view) demonstrates the collapse of the humeral head and an intact rotator cuff.
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fig4: Case  2. Magnetic resonance image (MRI) of the left shoulder at symptom onset (a, b) and at the first visit to our hospital (c). (a) T2-weighted MRI (oblique coronal plane) demonstrates joint effusion and a slightly collapsed humeral head. (b) Axial, T1-weighted MRI shows a subchondral serpiginous pattern of low signal intensity with associated bone marrow edema. (c) T2-weighted MRI (coronal view) demonstrates the collapse of the humeral head and an intact rotator cuff.

Mentions: Radiography demonstrated that the humeral head was slightly displaced inferiorly, but its shape was maintained at the time of symptom onset (Figure 3(a)). Subsequent radiographs, taken 5 months later, revealed collapse of the humeral head (Figure 3(b)). Upon the patient's first visit to our hospital, 2 years after symptom onset, the radiographs demonstrated bone defects of the glenoid (Figure 3(c)). At symptom onset, oblique coronal MRI showed joint effusion and slight collapse of the humeral head (Figure 4(a)). An axial T1-weighted MRI showed a subchondral serpiginous pattern of low signal intensity with associated bone marrow edema (Figure 4(b)). At our hospital, oblique coronal MRI demonstrated the collapse of the humeral head, but the rotator cuff remained intact. Tumors, synovial hyperplasia, and intraosseous cystic lesions were not demonstrated (Figure 4(c)).


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  2. Magnetic resonance image (MRI) of the left shoulder at symptom onset (a, b) and at the first visit to our hospital (c). (a) T2-weighted MRI (oblique coronal plane) demonstrates joint effusion and a slightly collapsed humeral head. (b) Axial, T1-weighted MRI shows a subchondral serpiginous pattern of low signal intensity with associated bone marrow edema. (c) T2-weighted MRI (coronal view) demonstrates the collapse of the humeral head and an intact rotator cuff.
© Copyright Policy
Related In: Results  -  Collection

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

fig4: Case  2. Magnetic resonance image (MRI) of the left shoulder at symptom onset (a, b) and at the first visit to our hospital (c). (a) T2-weighted MRI (oblique coronal plane) demonstrates joint effusion and a slightly collapsed humeral head. (b) Axial, T1-weighted MRI shows a subchondral serpiginous pattern of low signal intensity with associated bone marrow edema. (c) T2-weighted MRI (coronal view) demonstrates the collapse of the humeral head and an intact rotator cuff.
Mentions: Radiography demonstrated that the humeral head was slightly displaced inferiorly, but its shape was maintained at the time of symptom onset (Figure 3(a)). Subsequent radiographs, taken 5 months later, revealed collapse of the humeral head (Figure 3(b)). Upon the patient's first visit to our hospital, 2 years after symptom onset, the radiographs demonstrated bone defects of the glenoid (Figure 3(c)). At symptom onset, oblique coronal MRI showed joint effusion and slight collapse of the humeral head (Figure 4(a)). An axial T1-weighted MRI showed a subchondral serpiginous pattern of low signal intensity with associated bone marrow edema (Figure 4(b)). At our hospital, oblique coronal MRI demonstrated the collapse of the humeral head, but the rotator cuff remained intact. Tumors, synovial hyperplasia, and intraosseous cystic lesions were not demonstrated (Figure 4(c)).

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