Steroid induced avascular necrosis of the head of the humerus. Natural history and management

Abstract

Ninety five patients with seroid induced avascular necrosis of bone have been personally treated by the author. Of these, eighteen had a lesion of the head of the humerus, on one or both sides. The conditions for which the steroids were given included post transplantation, lupus erythematosus, glomerulonephritis and asthma. The characteristic lesion began as a subchondral osteolytic area which frequently progressed to collapse. The articular cartilage divided from the subchondral bone, either becoming detached as a free cap or at a later stage reattaching. In some cases the lesion was minimal and the symptoms were slight. Conservative treatment has consisted of pendulum exercises and avoidance of abduction, particularly against resistance. In 14 patients this led to satisfactory function with only intermittent symptoms. Four patients required replacement of 5 humeral heads with Neer's prostheses. After 1 to 7 years the results of all 5 were classified as excellent in terms of absence of symptoms and a free range of movement.