Rapid destruction of the humeral head due to bone fragility: report of two cases

Yoshikawa, Katsuhisa; Tamai, Kazuya; Yano, Yuichiro; Kato, Nakayuki; Akutsu, Miwa; Tomizawa, Kazuo; Nohara, Yutaka

doi:10.1007/s00776-012-0290-0

Cited by 5 publications

(9 citation statements)

References 8 publications

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“…In our case 2, MRI showed these typical findings. Recently, Yoshikawa et al [ 6 ] and Tokuya et al [ 5 ] reported that the cause of shoulder RDA was SIF due to bone fragility, as previously reported for the hip joint. In the present study, both of our cases showed decreased BMD (osteoporosis).…”

Section: Discussionmentioning

confidence: 67%

“…Motomura et al [ 11 ] have suggested that SIF of the femoral head and acetabulum may produce more excessive load on the cartilage, leading to rapid destruction of the hip joint, compared with the destruction associated with an isolated femoral head lesion. Yoshikawa et al [ 6 ] reported 2 RDA cases without SIF of the glenoid. In their report, the times to humeral head collapse were 3 or 8 months ( Table 1 ).…”

Section: Discussionmentioning

confidence: 99%

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Rapid Destruction of the Humeral Head Caused by Subchondral Insufficiency Fracture: A Report of Two Cases

Goshima

Kitaoka²,

Nakase

et al. 2015

Case Reports in Orthopedics

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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.

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Rapid Destruction of the Humeral Head Caused by Subchondral Insufficiency Fracture: A Report of Two Cases

Goshima

Kitaoka²,

Nakase

et al. 2015

Case Reports in Orthopedics

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“…Very recently, subchondral insufficiency fractures (SIFs) of the shoulder have been described as a cause of rapid joint destruction [1,2,4,5]. SIF is a recently proposed concept and is thought to cause femoral head collapse associated with RDA of the hip [6,7].…”

Section: Introductionmentioning

confidence: 99%

“…It was thought to occur secondary to physiological stress applied to a weakened bone due to reduced bone mineralization, commonly seen in elderly women with osteoporosis [9]. Although the pathogenesis of RDA of the shoulder remains unclear, there have been several reports for RDA resulting from SIF of the shoulder [1,2,4,5]. Magnetic resonance imaging (MRI) plays an important role in the diagnosis of SIF, which is often inconspicuous on initial radiographs [6].…”

Section: Introductionmentioning

confidence: 99%

“…To the best of our knowledge, only 25 cases of RDA due to SIF of the shoulder have been reported as case reports or small case series [1,2,4,5,10,11]. Because of its rarity and related gaps in knowledge, this condition might be misdiagnosed as idiopathic destructive arthritis of the shoulder, osteonecrosis of the humeral head, Milwaukee shoulder syndrome, infectious arthritis, or osteomyelitis [12,13].…”

Section: Introductionmentioning

confidence: 99%

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Rapid Destructive Arthrosis Due to Subchondral Insufficiency Fracture of the Shoulder: Clinical Characteristics, Radiographic Appearances, and Outcomes of Treatment

et al. 2020

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The purpose of our study was the clinical characteristics, radiographic appearance, and outcomes after treatment in patients with rapid destructive arthrosis (RDA) due to subchondral insufficiency fracture (SIF) of the shoulder. Twenty-two cases of RDA of the shoulder were retrospectively reviewed. Clinical outcomes for 15 cases who underwent shoulder arthroplasty were evaluated at an average of 41.4 months. The mean age of patients was 73.7 years (range 50–83 years), and there were 20 women and 2 men. The mean time from onset of symptoms to head collapse was 6.8 months (range 1–12 months). The mean t-score of bone mineral density was −3.1. Nine patients had pseudoparalysis. Based on radiographic appearance, a diversity of types of head destruction with subchondral fracture, bone marrow edema, joint effusion, and synovitis were observed in all cases. In conclusion, RDA due to SIF of the shoulder, presenting with severe short-term pain and functional disability, commonly occurred in elderly women with bone fragility. MRI revealed bone marrow edema, extensive joint effusion, and synovitis as well as a diversity of types of head destruction with subchondral fracture within several months from onset of symptoms.

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MRI of subchondral fractures: a review

Viana¹,

Machado²,

Mendlovitz

2014

Skeletal Radiol

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Several authors have recently emphasized the role of magnetic resonance imaging (MRI) in the diagnosis of subchondral fractures. There is increasing interest about this type of fractures, mostly because they have been implicated in the genesis of some well-known destructive articular conditions whose cause was previously undetermined, such as distal clavicular osteolysis, rapidly progressive osteoarthritis of the hip, spontaneous osteonecrosis of the knee and adult-type Freiberg's infraction. Subchondral fractures may ultimately lead to bone collapse, secondary osteonecrosis and severe articular damage, and there may be rapid progression of joint destruction over a period of weeks to months. It has been suggested that timely diagnosis might potentially improve the outcome and avoid the onset of destructive joint disease, making MRI even more important in this setting. The fracture line usually appears as a band of low signal intensity in the subchondral bone plate, adjacent to the articular surface, most often surrounded by bone marrow edema. In this article the authors review the most relevant imaging features of subchondral fractures in several joints, stressing the importance of early recognition for a better outcome.

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Rapid destruction of the humeral head due to bone fragility: report of two cases

Cited by 5 publications

References 8 publications

Rapid Destruction of the Humeral Head Caused by Subchondral Insufficiency Fracture: A Report of Two Cases

Rapid Destruction of the Humeral Head Caused by Subchondral Insufficiency Fracture: A Report of Two Cases

Rapid Destructive Arthrosis Due to Subchondral Insufficiency Fracture of the Shoulder: Clinical Characteristics, Radiographic Appearances, and Outcomes of Treatment

MRI of subchondral fractures: a review

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