Osteonecrosis of Shoulder

Osteonecrosis of Shoulder

Article
Bone, Muscle, & Joint
Sports Medicine
+1
Contributed byMaulik P. Purohit MD MPHOct 19, 2018

What are the other Names for this Condition? (Also known as/Synonyms)

  • Avascular Necrosis of Shoulder
  • Ischemic Necrosis of Shoulder
  • Shoulder Osteonecrosis

What is Osteonecrosis of Shoulder? (Definition/Background Information)

  • Osteonecrosis (or avascular necrosis) is a serious bone disorder characterized by the temporary or permanent disruption of blood supply to the bone, which causes cells and tissues within the affected bone to die. In many, osteonecrosis affects the ends of the long bones in the body
  • Osteonecrosis of Shoulder affects bones in the shoulder; and, in a vast majority of cases, the end of the upper arm bone (called humeral head) is affected. The cause of Shoulder Osteonecrosis may be categorized as either traumatic or non-traumatic
  • Trauma to the shoulder causing bone fracture may occur from participation in sports or vehicular accidents; while, non-traumatic causes include the use of steroids, cancer therapy, alcoholism; or, it may even be idiopathic (of unknown origin)
  • Individuals, who develop Osteonecrosis of Shoulder, begin to experience pain within the affected shoulder joint that usually progresses slowly. This may be accompanied by tenderness, swelling, and reduced range of shoulder joint movement
  • Treatment associated with Osteonecrosis of Shoulder includes both nonsurgical and surgical methods. With early diagnosis and appropriate treatment, the prognosis is usually good. However, the prognosis also depends upon the severity of the condition and the underlying cause of Shoulder Osteonecrosis

Who gets Osteonecrosis of Shoulder? (Age and Sex Distribution)

  • Osteonecrosis of Shoulder may occur in individuals of all age, race, ethnic groups, and any gender
  • A high percentage of individuals who develop the condition are young, middle-aged, or slightly older men in the age group 30-60 years
  • Some reports indicate that males are affected twice more than females (male-female ratio of 2:1)

What are the Risk Factors for Osteonecrosis of Shoulder? (Predisposing Factors)

Common risk factors associated with Osteonecrosis of Shoulder include:

  • Individuals, who sustain a dislocation or fracture, while participating in sports such as football or basketball
  • Vehicular or industrial accidents involving the shoulder joint; fall injuries
  • Excessive consumption of alcohol
  • Prolonged consumption of steroids, such as prednisone or glucocorticoids
  • Myeloproliferative disorder: A bone marrow disorder characterized by the abnormal increase of red blood cells
  • Cancer treatment using radiotherapy or chemotherapy
  • Systemic lupus erythematosus (SLE): Autoimmune systemic inflammatory conditions that occur when an individual’s immune system create antibodies, which accidentally attack healthy tissues and organs within the body
  • Decompression sickness: A disorder characterized by abnormal formation of nitrogen bubbles within the blood and tissues, usually seen in divers when they move up from the water (high-pressure medium) to the surface (low-pressure medium) too soon
  • Sickle cell anemia: An inherited condition characterized by crescent-shaped red blood cells in the body, obstructing blood flow and causing reduced amounts of oxygen transportation
  • Gaucher’s disease: A rare inherited disorder caused by excessive accumulation of fatty substances (lipid) in the cells and certain organs. This excess build-up of fatty substances can prevent the liver, spleen, lungs, bone marrow, and in rare cases the brain, from functioning properly
  • Crohn’s disease: A disease causing inflammation of the digestive tract lining
  • Antiphospholipid syndrome; an autoimmune disorder
  • High cholesterol level causing hyperlipidemia
  • Excess level of uric acid in blood causing hyperuricemia
  • Arterial embolism: Blood flow obstruction to an organ or body part, caused due to an embolus (a blood clot or fat particle) within the artery
  • Thrombosis: Blood clot that occurs within blood vessels
  • Vasculitis: A condition that causes inflammation of blood vessels
  • Long-term tobacco smoking
  • Pregnancy, in some cases
  • Longstanding and uncontrolled diabetes mellitus

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Osteonecrosis of Shoulder? (Etiology)

In Osteonecrosis of Shoulder, there is a loss of blood supply to the bone leading to its destruction and necrosis (tissue death). This blood supply loss may occur from a variety of factors that may be grouped as traumatic or non-traumatic. In some cases, the exact cause of osteonecrosis may remain unidentified (idiopathic).

Traumatic factors for Shoulder Osteonecrosis include:

  • Injuries during sports participation causing shoulder fracture or dislocation
  • Vehicular accidents
  • Fall injuries

Atraumatic factors for Shoulder Osteonecrosis include:

  • Excessive alcohol consumption and prolonged use of corticosteroids, which together account for most of the cases of Shoulder Osteonecrosis from non-traumatic factors
  • Individuals with HIV infection or AIDS
  • Perthes disease: Children who develop a rare childhood hip disorder caused by the temporary loss of blood flow to the ball portion of the hip joint
  • Peripheral vascular disease: The contraction and hardening of blood vessels within the legs and feet
  • Slipped capital femoral epiphysis: Adolescents develop this unusual condition, due to a weakness of the growth plate, causing the femur/thighbone head to slip backwards
  • Sickle cell anemia: A genetic condition caused by odd-shaped red blood cells that tend to obstruct the flow of blood to different body parts
  • Systemic lupus erythematosus (or lupus): An auto-immune systemic inflammatory condition that occurs when an individual’s immune system create antibodies that accidentally attack healthy tissues and organs within the body
  • Decompression sickness: A disorder characterized by abnormal formation of nitrogen bubbles within the blood and tissues, usually seen in divers when they move up from the water to the surface too soon
  • Radiation therapy, which uses high-energy beams to shrink tumors and destroy cancer cells
  • Use of certain medications, such as during chemotherapy, steroids (usually high-dose), or immunosuppressive medications for organ transplant
  • Excess fat in the body; obesity
  • Pancreatitis: Inflammation of the pancreas

What are the Signs and Symptoms of Osteonecrosis of Shoulder?

The signs and symptoms of Osteonecrosis of Shoulder may be mild or severe and can vary from one individual to another. In some cases, there may be the involvement of more than one bone. Also, initially, there may not be any noticeable symptoms.

The signs and symptoms may of Shoulder Osteonecrosis include:

  • Noticeable pain and tenderness in the affected bone; the pain increases when pressure is applied to the shoulder (such as while sleeping on the shoulder)
  • The pain may be either dull or sharp and shooting pain
  • Swelling of tissue around the affected shoulder bone/humerus or joint
  • Decreased range of motion of the affected joint/bone
  • Crunching or popping sound with movement of the affected shoulder joint

How is Osteonecrosis of Shoulder Diagnosed?

Diagnostic methods that a physician may use to help diagnose Osteonecrosis of Shoulder include:

  • Physical examination and evaluation of medical history
  • Assessment of the signs and symptoms
  • Functional evaluation of the affected bone
  • Tests and procedures to diagnose any underlying condition, if any
  • X-ray of the affected shoulder: X-rays can help the physician rule-out other possible causes of shoulder discomfort. During the early stages of osteonecrosis, it is difficult to locate the appearance of any abnormal bone changes. However, X-rays can usually identify the presence of osteonecrosis during the later stages
  • Magnetic resonance imaging (MRI) of the shoulder joint: An MRI is an imaging technique that creates images of soft tissues and bones, which helps detect any bone abnormalities, during the early stages of osteonecrosis
  • Bone scan: A bone scan is a diagnostic method used to identify any bone abnormalities by injecting tiny amounts of radioactive material into the bloodstream
  • Computerized tomography (CT) of the shoulder joint: A CT scan takes a series of X-ray images from several different angles, which are then merged to create cross-sectional images of bones and soft tissues of the body. This allows a physician to examine the bone or joint and its surrounding structures

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Osteonecrosis of Shoulder?

The complications associated with Osteonecrosis of Shoulder may include:

  • Further deterioration of the involved bone
  • If left untreated, the bone may collapse
  • Increased risk for fractures
  • Immobility of the affected shoulder
  • Chronic disability
  • Complications that arise from any underlying condition, if present

How is Osteonecrosis of Shoulder Treated?

The treatment of Shoulder Osteonecrosis includes non-surgical and surgical methods and may depend on the severity of the condition (mild or severe). A healthcare provider may start with non-surgical treatment methods before adopting surgical procedures and techniques. These include:

  • Applying ice to the region can help with pain and reduce swelling
  • Avoiding further stress on the involved bone
  • Non-steroidal anti-inflammatory oral medications, such as ibuprofen and naproxen, may be used to help decrease pain and swelling
  • Medications for osteonecrosis may decrease the progression of this condition
  • Corticosteroid injections help provide temporary relief of symptoms and in improving the range of motion. It is important to note that corticosteroid injections only give temporary relief. Prolonged episodes of such injections may injure the joints in the long-run
  • Electrical stimulation therapy to aid in the growth of the affected bone
  • After the symptoms has decreased, it is important to begin some light motion exercises.  Physical therapy may help restore strength, as well as provide flexibility, to the muscles

Surgical treatment measures include:

  • Osteotomy: The affected bone is surgically removed/cut and reshaped or realigned
  • Core decompression: Core decompression is used to treat early-stage osteonecrosis. In this surgical procedure the pressure within the bone is decreased by removing a part of the bone causing the abnormal pressure
  • Bone grafting: It is a technique that involves removing a healthy bone from within the body and replacing the affected bone
  • Humeral head resurfacing; when the injured head of the upper arm bone is capped with a metal prosthetic device after smoothening the head
  • Partial or total replacement of the involved joint: The involved joint is replaced through a surgical procedure using a prosthetic implant. A physician will recommend this surgical procedure, if the condition is limited to a certain portion of the joint
  • Total arthroplasty: In total arthroplasty, the involved joint cartilage is completely removed. It is then replaced by a metal and plastic prosthetic implant. This surgical procedure is recommended, if the entire joint is acutely affected
  • Cartilage grafting: Cartilage grafting is a surgical procedure to replace the damaged cartilage, which may be damaged due to osteonecrosis or any traumatic injury
  • Stem cell therapy via stem cell injections may be an alternative to surgery, especially for young sports athletes

Additionally, suitable treatment of any underlying condition/disorder should be undertaken.

How can Osteonecrosis of Shoulder be Prevented?

A few recommendations to help prevent Osteonecrosis of Shoulder include:

  • Avoid excessive intake of alcoholic beverages
  • Monitor long-term consumption of steroidal medications
  • Individuals, who participate in any high-risk sports, such as football or hockey, should wear appropriate safety equipment to help prevent a serious injury
  • Undertaking adequate treatment for health conditions such as lupus
  • Wear proper equipment while scuba-diving to avoid decompression sickness
  • Maintain a low cholesterol diet
  • Avail proper treatment that can help control or minimize blood vessel damage, associated with vasculitis
  • Proper treatment of Crohn’s disease will help prevent the development of osteonecrosis
  • Undertake proper treatment of myeloproliferative disorder
  • Treatments that improve the blood flow to organs or any body part
  • Proper treatment of blood clots that occur within blood vessels

What is the Prognosis of Osteonecrosis of Shoulder? (Outcomes/Resolutions)

  • If treated early, a high percentage of individuals who develop Osteonecrosis of Shoulder may show an improvement and experience favorable outcomes; the bone may rebuild itself
  • In general, the amount of bone damaged by this condition significantly affects its prognosis. A delay in treatment or an absence of treatment can severely affect the prognosis and cause functional loss of the involved bone

Additional and Relevant Useful Information for Osteonecrosis of Shoulder:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/health-topics/orthopedc-disorders/

Was this article helpful

On the Article

Maulik P. Purohit MD MPH picture
Approved by

Maulik P. Purohit MD MPH

Assistant Medical Director, Medical Editorial Board, DoveMed Team

0 Comments

Please log in to post a comment.

Related Articles

Test Your Knowledge

Asked by users

Related Centers

Loading

Related Specialties

Loading card

Related Physicians

Related Procedures

Related Resources

Join DoveHubs

and connect with fellow professionals

Related Directories

Who we are

At DoveMed, our utmost priority is your well-being. We are an online medical resource dedicated to providing you with accurate and up-to-date information on a wide range of medical topics. But we're more than just an information hub - we genuinely care about your health journey. That's why we offer a variety of products tailored for both healthcare consumers and professionals, because we believe in empowering everyone involved in the care process.
Our mission is to create a user-friendly healthcare technology portal that helps you make better decisions about your overall health and well-being. We understand that navigating the complexities of healthcare can be overwhelming, so we strive to be a reliable and compassionate companion on your path to wellness.
As an impartial and trusted online resource, we connect healthcare seekers, physicians, and hospitals in a marketplace that promotes a higher quality, easy-to-use healthcare experience. You can trust that our content is unbiased and impartial, as it is trusted by physicians, researchers, and university professors around the globe. Importantly, we are not influenced or owned by any pharmaceutical, medical, or media companies. At DoveMed, we are a group of passionate individuals who deeply care about improving health and wellness for people everywhere. Your well-being is at the heart of everything we do.

© 2023 DoveMed. All rights reserved. It is not the intention of DoveMed to provide specific medical advice. DoveMed urges its users to consult a qualified healthcare professional for diagnosis and answers to their personal medical questions. Always call 911 (or your local emergency number) if you have a medical emergency!