title: Rapid destruction of the humeral head caused by subchondral insufficiency fracture: a report of two cases.
abstract: Rapidly destructive arthritis (RDA) of the shoulder is a rare disease. Here, we report two cases, with different destruction patterns, which were most probably due to subchondral insufficiency fractures (SIFs). Case 1 involved a 77-year-old woman with right shoulder pain. Rapid destruction of both the humeral head and glenoid was seen within 1 month of the onset of shoulder pain. We diagnosed shoulder RDA and performed a hemiarthroplasty. Case 2 involved a 74-year-old woman with left shoulder pain. Humeral head collapse was seen within 5 months of pain onset, without glenoid destruction. Magnetic resonance imaging showed a bone marrow edema pattern with an associated subchondral low-intensity band, typical of SIF. Total shoulder arthroplasty was performed in this case. Shoulder RDA occurs as a result of SIF in elderly women; the progression of the joint destruction is more rapid in cases with SIFs of both the humeral head and the glenoid. Although shoulder RDA is rare, this disease should be included in the differential diagnosis of acute onset shoulder pain in elderly female patients with osteoporosis and persistent joint effusion.
authors.affiliation: Department of Orthopaedic Surgery, Toyama Municipal Hospital, 2-1 Imaizumi Hokubu-machi, Toyama 939-8511, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Goshima
authors.affiliation: Department of Orthopaedic Surgery, Kijima Hospital, 41-1 Matsudera-machi, Kanazawa 920-0011, Japan.
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Kitaoka
authors.affiliation: Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa 920-8641, Japan.
authors.forename: Junsuke
authors.initials: J
authors.lastname: Nakase
authors.affiliation: Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa 920-8641, Japan.
authors.forename: Hiroyuki
authors.identifier: 0000-0003-0730-7921
authors.initials: H
authors.lastname: Tsuchiya