Goshima Kenichi, Kitaoka Katsuhiko, Nakase Junsuke, Tsuchiya Hiroyuki
Department of Orthopaedic Surgery, Toyama Municipal Hospital, 2-1 Imaizumi Hokubu-machi, Toyama 939-8511, Japan.
Department of Orthopaedic Surgery, Kijima Hospital, 41-1 Matsudera-machi, Kanazawa 920-0011, Japan.
Case Rep Orthop. 2015;2015:251696. doi: 10.1155/2015/251696. Epub 2015 Apr 6.
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.
肩部快速破坏性关节炎（RDA）是一种罕见疾病。在此，我们报告两例具有不同破坏模式的病例，极有可能是由于软骨下不全骨折（SIF）所致。病例1为一名77岁女性，出现右肩疼痛。在肩部疼痛发作1个月内，可见肱骨头和关节盂均迅速破坏。我们诊断为肩部RDA并实施了半关节置换术。病例2为一名74岁女性，出现左肩疼痛。在疼痛发作5个月内可见肱骨头塌陷，无关节盂破坏。磁共振成像显示骨髓水肿模式并伴有软骨下低强度带，这是SIF的典型表现。该病例实施了全肩关节置换术。肩部RDA是老年女性SIF的结果；肱骨头和关节盂均发生SIF的病例中，关节破坏进展更快。尽管肩部RDA罕见，但在患有骨质疏松症且持续关节积液的老年女性患者急性发作肩部疼痛的鉴别诊断中应考虑此病。
