| |
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
|
