Monday, January 19, 2015

Rapidly destructive glenohumeral arthritis

Rapidly destructive arthrosis of the shoulder joints: radiographic, magnetic resonance imaging, and histopathologic findings.

These authors present 9 women (mean age of 72 years (range, 63-85 years)) having shoulder arthroplasty that demonstrated a pattern of rapid collapse of the humeral head over 6 months from symptom onset as seen on plain radiography and magnetic resonance imaging (MRI) within 12 months from symptom onset. These patients had no history of  trauma, rheumatoid arthritis, steroid intake, neurologic osteoarthropathy, osteonecrosis, renal osteoarthropathy, or gout.

All patients showed a unique pattern of humeral head flattening, which appeared like a clean surgical cut with bone debris around the humeral head. MRI findings revealed significant joint effusion and bone marrow edema in the humeral head, without involvement of the glenoid. Pathologic findings showed both fragmentation and regeneration of bone matrix. Seven of the shoulders had large rotator cuff tears.

Comment: This description is interesting. This condition seems to have some features that resemble cuff tear arthropathy, others that resemble osteopenic fatigue fracture, and others suggesting avascular necrosis, while not being absolutely characteristic of any of these. We having a pending case in a 70 year old woman not exactly like those in this report, but similar in that over 8 months, without any evidence of infection or other underlying cause progressed from this characteristic picture of cuff tear arthropathy
 to this picture of destruction involving (in contrast to those in the report) the glenoid as well as the humeral articular surface.

The bottom line may be that there are many variations on the theme of glenohumeral arthritis, each requiring an individualized approach.


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