Learning Radiology xray montage
 
 
 
 
 

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

Cruess Classification

Stage

Findings

Stage I

Normal x-ray. Changes on MRI

Stage II

Sclerosis (wedged, mottled), osteopenia

Stage III

Crescent sign indicating a subchondral fracture

Stage IV

Flattening and collapse

 

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 

 
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

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.