Review Question - QID 3501

The atraumatic lesion shown in Figure A is most consistent with osteonecrosis (also known as avascular necrosis, or AVN). Initial MRI findings of AVN include decreased signal intensity in the subchondral region on both T1- and T2-weighted images, suggesting edema in early disease. In the shoulder, this is most commonly associated with the chronic use of corticosteroids, such as prednisone.

Sarris et al provide a review of osteonecrosis of the shoulder. They state that treatment is most effectively guided by staging of the disease, and that stage I and II disease can be treated conservatively. Surgical intervention is advocated when the patient is persistently symptomatic, and signs of articular collapse are evident. The surgical options include arthroscopic débridement, core decompression, vascularized bone grafting, and shoulder arthroplasty.

Incorrect Answers:
1-Gaucher disease is usually associated with large boney infarcts on MRI and severe pain. It is also a less common cause of AVN than chronic corticosteroid use.
2-Osteoarthritis is not frequently associated with subchondral collapse and fragmentation, especially in the absence of prior symptoms.
3-Chronic rotator cuff tendinopathy does not typically present with the changes noted on the MRI in Figure A.
5-Calcific tendinitis usually presents with severe acute pain, and a hypointense area within the soft tissues around the shoulder representing the calcific deposit. An example of calcific tendinitis is shown in Illustration A.