Epiphyseal "systemic" osteonecrosis of humeral head.

A 47-year-old man presented to the Emergency department for a strong right shoulder pain with functional disability. This pain had evolved for a few weeks, without traumatic notion and in clear worsening in spite of regular taking of antalgics. The shoulder stump palpation woke the pain. The patient’s medical history included non-insulin-dependent diabetes, osteoporosis, and stomach ulcer. We also noted an important ethylic and smoking intoxication. A right shoulder radiography was performed (Fig. A) that showed osteonecrosis of the humeral head associating a wide heterogeneous change centered on the epiphysis encircled by a border sclera with an irregular aspect of subchondral bone and collapse of the head. The patient was sent to orthopaedic surgery consultation. CT-arthrography (Fig. B, C) showed a subchondral dissection with an osteocartilaginous fragment (arrows) of practically 2 cms in the upper joint recessus but rest exceptionally attached to the humeral head.