誘因なく急速に上腕骨頭の破壊をきたした１例

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  • Rapid Destruction of the Humeral Head: A Case Report

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We report a patient with spontaneous rapid destruction of the humeral head mimicking femoral head destruction in rapidly destructive coxopathy. A 78-year-old woman developed pain in her right shoulder and visited an orthopedist in August 2008. Infectious arthritis was denied and the patient was given an intra-articular corticosteroid injection and oral NSAIDs. However, the shoulder pain persisted, resulting in humeral head destruction on the follow-up x-ray. She was referred to us in November 2008. She reported a history of diabetes, hypertension and osteoporosis but no history of oral corticosteroid use or alcohol drinking. On examination, she reported tenderness over the anterior and posterior aspect of the right shoulder, and the acitve range of the motions were limited in flexion and external and internal rotations. Neurological findings were intact. Blood test did not reveal inflammation, while urine test revealed a slight increase in deoxypyridinoline. X-ray showed significant humeral head collapse and glenoid degeneration. MRI revealed that the rotator cuff was preserved. Since infection or neuropathic diseases were unlikely, the patient underwent total shoulder arthroplasty. Operative findings revealed that the articular cartilage of the humeral head and of the glenoid had disappreared, associated with eburnation of the subchondral bone. Histological findings revealed that the humeral head was not extensively necrotic, but rather included new bone repair as in fracture. The postoperative course was unremarkable. It has been indicated that insuficency fracture precedes rapidly destructive coxopathy in the elderly . We believe that a similar process may have caused rapid destruction of the shoulder in this case.

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  • 肩関節

    肩関節 34 (2), 557-560, 2010

    日本肩関節学会

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