Avascular Necrosis of the Humeral Head

General Considerations

• Second most common joint for avascular necrosis (AVN) to hip
• Causes include
• Mechanical disruption from trauma
• Steroid-induced disease
• Sickle cell disease
• Alcohol abuse

Clinical Findings

• Insidious onset of pain
• Pain, poorly localized and usually severe
• Night and rest pain
• Range of motion is initially preserved
  

Imaging Findings

• Radiographs will be normal early in disease
• Then resorption in superior middle portion of humeral head
• Crescent sign (lucency) consistent with subchondral collapse
• Relative increase in density of head
• Can progress to osteoarthritic changes of joint eventually
• MRI preferred imaging modality
• Subchondral edema
• Low signal serpiginous line
• Double line sign (inner bright line from granulation tissue and outer dark line from sclerotic bone) on T2-weighted images

Differential Diagnosis

• Osteoarthritis involves both sides of the joint

Treatment

• Conservative treatment includes pain medication, physical therapy
• Operative procedures from core decompression to total shoulder arthroplasty

 
Avascular Necrosis of the Humeral head. There is a relative increase in density in the humeral head (white arrows) with a subchondral lucency seen in the medial portion of the head. The shoulder joint space is still preserved (red arrow).

Avascular Necrosis of the Humeral head. There is a relative increase in density in the humeral head with irregularity in the surface of the head. The shoulder joint space is still preserved.