Avascular necrosis of the humeral head - natural progression

A man presented with the atraumatic onset of right shoulder pain. He had no history of excess alcohol use or steroid use other than three injections. Here are a series of images that show the progression of his AVN (see link here and here).

August 2013

Essentially normal x-ray

February 2015

Some sclerosis of the superior medial humeral articular surface

 February 2015

MRI showing subsurface crack in the humeral head

February 2016

Early collapse of the avascular segment

May 2016

Surgical photo showing break in articular surface

May 2016

Corss section showing crack beneath joint surface

May 2016

Impaction grafted hemiarthroplasty selected because of retained glenoid articular cartilage

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