Avascular necrosis of the shoulder, x-ray appearance

Avascular necrosis is a condition in which the blood supply to the humeral head is compromised, resulting in death and eventual collapse of the humeral joint surface. Common contributing factors are steroid medications, alcoholism, fracture, prior surgery and inflammatory joint disease. A typical case is shown here. And here is another.

As we've emphasized before (see here), two plain x-rays are necessary and sufficient to make most diagnoses of shoulder arthritis.

Here is an anteroposterior (AP) and an axillary view typical of shoulders with avascular necrosis.

The upper view, the AP shows complete collapse of the humeral head with minimal glenoid deformity.

The standardized axillary view reveals much more of the pathology: glenoid is convex and the concave humeral head is collapsed around it.

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