Monday, November 12, 2012

Bilateral avascular necrosis after steroids for asthma

We had the pleasure of caring for a 30 year old woman who presented initially with right shoulder pain. She had had a couple of severe asthma episodes with use of prednisone for the attacks. Once she had to be intubated for acute respiratory distress. She has been on steroids several other times. Her shoulder started hurting her a couple of months prior to her initial visit without injury or incident, and had progressively gotten worse. She was to the point to where she could barely use the shoulder at all and it was affecting all of her daily activities due to motion loss and pain.

Her plain x-ray looked like this

and her MRI revealed the diagnosis of avascular necrosis with a crack below the joint surface of the humeral head.

A hemiarthroplasty performed with impaction grafting of a press fit implant gave her excellent return of comfort and function.

A year later she returned with similar symptoms on the opposite side and this x-ray.

and this MRI

A second humeral hemiarthroplasty has restored comfort and function to this shoulder.

At surgery the humeral head showed central collapse

It is to be noted that the hemiarthroplasty with impaction grafting allowed for anatomic reconstruction of the shoulder, secure fixation of the humeral component, and freedom from cement or bone ingrowth that would complicate future revision surgery should it become necessary.

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