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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

Histologic features of the excised humeral head in patient 2 (hematoxylin-eosin staining). (a) A coronal section of the humeral head exhibits the collapse of the subchondral area and articular cartilage defects (×1.25). (b) The bone trabeculae are mostly vital but focally necrotic. New bone formation is seen around the necrotic bone trabeculae (×100).
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fig5: Histologic features of the excised humeral head in patient 2 (hematoxylin-eosin staining). (a) A coronal section of the humeral head exhibits the collapse of the subchondral area and articular cartilage defects (×1.25). (b) The bone trabeculae are mostly vital but focally necrotic. New bone formation is seen around the necrotic bone trabeculae (×100).

Mentions: A total shoulder arthroplasty was carried out because the rotator cuff was intact. The excised humeral head had detached articular cartilage and collapsed subchondral bone. Histologically, the articular cartilage was lost. In the subchondral area, the bone trabeculae were mostly vital but were focally necrotic. New bone formation was seen around the necrotic bone trabeculae (Figure 5).


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)

Histologic features of the excised humeral head in patient 2 (hematoxylin-eosin staining). (a) A coronal section of the humeral head exhibits the collapse of the subchondral area and articular cartilage defects (×1.25). (b) The bone trabeculae are mostly vital but focally necrotic. New bone formation is seen around the necrotic bone trabeculae (×100).
© Copyright Policy
Related In: Results  -  Collection

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

fig5: Histologic features of the excised humeral head in patient 2 (hematoxylin-eosin staining). (a) A coronal section of the humeral head exhibits the collapse of the subchondral area and articular cartilage defects (×1.25). (b) The bone trabeculae are mostly vital but focally necrotic. New bone formation is seen around the necrotic bone trabeculae (×100).
Mentions: A total shoulder arthroplasty was carried out because the rotator cuff was intact. The excised humeral head had detached articular cartilage and collapsed subchondral bone. Histologically, the articular cartilage was lost. In the subchondral area, the bone trabeculae were mostly vital but were focally necrotic. New bone formation was seen around the necrotic bone trabeculae (Figure 5).

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