Avascular necrosis. A case history and literature review.
We describe a patient with avascular necrosis in both shoulders. Confirmatory testing in making the diagnosis included plain radiography, bone scan, and magnetic resonance imaging. The pathogenesis and staging of the disease by radiography are presented in the article. Treatment options include a conservative regimen of shoulder range of motion exercises and nonsteroidal anti-inflammatory agents or surgery (arthroplasty or core decompression). The patient's risk factors include long-term corticosteroid use, smoking, and alcohol consumption. Other known risk factors include sickle cell disease, Gaucher disease, chemotherapy, lymphoma, dysbaric conditions, and trauma. This literature search shows that prevention and early diagnosis lend the best outcomes for the diagnosis of avascular necrosis.
Wolfe
C J
CJ
Trinity Lutheran Family Medicine Center, Kansas City, Mo., USA. cwolfe@stormontrail.org
Taylor-Butler
K L
KL
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D019299:Decompression, Surgical; D003937:Diagnosis, Differential; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D006811:Humerus / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D008875:Middle Aged; D010020:Osteonecrosis / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D011859:Radiography; D016059:Range of Motion, Articular; D012307:Risk Factors; D012720:Severity of Illness Index; D012785:Shoulder Joint / Q000473:pathology / Q000503:physiopathology
D000894:Anti-Inflammatory Agents, Non-Steroidal