The humeral head: A review of the blood supply and possible link to osteonecrosis following rotator cuff repair

Keough, Natalie; Lorke, Dietrich

doi:10.1111/joa.13496

Cited by 14 publications

(23 citation statements)

References 56 publications

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“…To prevent RDON, Keough et al . highlighted the importance of avoiding damage to the vascularization of the humeral head upon arthroscopic RCR, while care should be taken not to damage the ACHA and anterolateral branch [ 7 ]. The vascular supply to the humeral head mainly involves the ACHA and posterior circumflex humeral artery [ 10 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, there was a study that reported that RDON could occur due to damage to the anterior circumflex humeral artery (ACHA), which is responsible for blood supply of the humeral head, depending on the location of the suture anchor. However, it was a cadaver study, not a study that analyzed actual patients [ 7 ]. Thus, owing to the lack of studies on exceptionally rare cases of humeral head osteonecrosis after arthroscopic RCR, the cause is yet to be clearly identified.…”

Section: Introductionmentioning

confidence: 99%

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Rapidly destructive osteonecrosis of the humeral head after arthroscopic rotator cuff repair: a case report

Kim

2022

BMC Musculoskelet Disord

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Background Cases of rapidly destructive osteonecrosis (RDON) of the humeral head after arthroscopic rotator cuff repair (RCR) have rarely been reported, which has prevented a clear consensus on the cause of osteonecrosis. Case presentation A 63-year-old woman without a history of trauma underwent arthroscopic RCR after being diagnosed with a medium-sized full-thickness rotator cuff tear for symptoms of left shoulder pain for six months. The patient had no medical history other than hypertension, and no other potential cause was found for osteonecrosis of the left shoulder prior to surgery. Four months after surgery, pain and range of motion improved. Six months after surgery, the patient complained of an increase in shoulder pain. While follow-up ultrasonography did not show a re-tear of the repaired tendon, osteonecrosis of the humeral head could not be confirmed as plain radiography was not performed. Follow up MRI performed a year after surgery revealed RDON of the humeral head. Despite mild improvement in the shoulder pain, the Shoulder Rating Scale of the University of California at Los Angeles (UCLA) and Constant score were poor at 23 and 69, respectively. In the present case, the arthroscopic RCR was performed using two anchors; for the repair of the anterior of the supraspinatus and the rotator interval, a 2.8-mm all-suture anchor was inserted into the upper part of the intertubercular groove. The cause of RDON is presumed to be the damage to the anterolateral and intraosseous branches of the anterior humeral circumflex artery (AHCA) for anchor positioning and insertion. Conclusions A poor outcome was obtained in the case of RDON, despite the integrity of the repaired rotator cuff tendon after arthroscopic RCR was intact. Although the cause of RDON has not been clearly established, care should be taken not to damage the anterolateral and intraosseous branches of the AHCA regarding the insertion location of the suture anchor, and to prepare the anchor in the vicinity of the intertubercular groove.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Rapidly destructive osteonecrosis of the humeral head after arthroscopic rotator cuff repair: a case report

Kim

2022

BMC Musculoskelet Disord

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“…Our aim was to examine a secondary penetration during follow-up at 1 year. The secondary penetration is due to either “sinking” of the humeral head during healing of the fracture (bone necrosis or remodeling) or to severe AVN with segmental collapse of the head [ 24 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

Pegs not superior to screws for fixation of fractures of the proximal humerus

et al. 2022

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Background Angular stable plates were introduced two decades ago as a promising treatment for fixation of displaced fractures of the proximal humerus (PHF). However, high rates of adverse events and reoperations have been reported. One frequent reason is secondary penetration of screws into the glenohumeral joint, due to sinking of the fracture or avascular head necrosis. To prevent joint penetrations angular stable plates with smooth locking pegs instead of locking screws have been developed. The aim of the present study was to investigate whether blunt pegs instead of pointed screws reduced the risk of secondary penetration into the glenohumeral joint during fracture healing after operatively treated PHFs. Methods From two different patient cohorts with displaced PHFs (60 treated with PHILOS plate with screws and 50 with ALPS-PHP plate with pegs), two groups were matched according to fracture type AO/OTA 11-B2 and 11-C2 and age (55–85 years). They were followed up at 3, 6 and 12 months. Primary outcome was radiographic signs of peg or screw penetrations into the glenohumeral joint at 12 months. Secondary outcomes were Oxford shoulder score (OSS) and Constant Score (CS) and radiographic signs of avascular humeral head necrosis (AVN). Results Eighteen PHILOS patients with B2 and C2 fractures could be matched with a corresponding group of 18 operated with ALPS-PHP with pegs. The number of penetrations of pegs and screws were equal between the two groups and the development of avascular head necrosis did not differ either. The functional outcomes for both OSS and CS at 12 months was clearly in favor of patients without joint penetrations in both groups. Conclusion We found no differences in the number of screw or peg penetrations in the PHILOS and ALPS-PHP group and the occurrence of AVN was equal. Joint penetrations led to inferior functional outcomes at 1 year. The ClinicalTrials.gov identifier 20/11/12 prospectively for the Philos Group is NCT01737060, and for the ALPS group 11/03/20 retrospectively is NCT04622852.

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“…El MR es el complejo tendinoso de cuatro músculos (supraespinoso, infraespinoso, redondo menor y subescapular) que se originan de la escápula y cuyos tendones se mezclan con la cápsula subyacente para insertarse en las tuberosidades del húmero. 6 Las funciones principales del manguito rotador son las siguientes: 7 1. Participa en la movilidad del hombro en rotaciones y abducción del húmero con respecto a la escápula.…”

Section: Anatomía Y Función Del Manguito Rotadorunclassified

Lesiones de manguito rotador: estado actual de la literatura con enfoque en rehabilitación

Toro¹,

González–Damián²,

Cruz‐Medina³

et al. 2023

Investigación en Discapacidad

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Las lesiones de manguito rotador son la principal causa de hombro doloroso. La evidencia y recomendaciones sobre su diagnóstico, tratamiento y rehabilitación se actualizan con rapidez. Clínicamente, se caracterizan por dolor localizado en hombro, cuello, brazo y región escapular, además de debilidad y limitación funcional. Es necesario realizar una evaluación clínica adecuada para tener un diagnóstico certero, así como llevar a cabo estudios complementarios. El tratamiento inicial es conservador y consiste en la combinación de medicamentos, fisioterapia y recomendaciones de cuidados articulares. La rehabilitación es básica en el tratamiento conservador, pre y postquirúrgico. El ejercicio es la intervención más eficaz en el tratamiento y la piedra angular de la rehabilitación. Conocer las bases del diagnóstico y tratamiento inicial permite al clínico elaborar programas basados en el paciente y su reintegración funcional. Este artículo de revisión profundiza en los puntos anteriores, al brindar una perspectiva general de las lesiones del manguito rotador y su proceso de rehabilitación.

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The humeral head: A review of the blood supply and possible link to osteonecrosis following rotator cuff repair

Cited by 14 publications

References 56 publications

Rapidly destructive osteonecrosis of the humeral head after arthroscopic rotator cuff repair: a case report

Rapidly destructive osteonecrosis of the humeral head after arthroscopic rotator cuff repair: a case report

Pegs not superior to screws for fixation of fractures of the proximal humerus

Lesiones de manguito rotador: estado actual de la literatura con enfoque en rehabilitación

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