Painful hematologic conditions affecting the shoulder.

Many patients have shoulder pain as a manifestation of the generalized hematologic disease or disorder. Therefore, the shoulder symptoms should respond to medical treatment of the underlying problem. Surgical treatment is required when there is extensive destruction of the humeral head. Osteonecrosis of the humeral head may be extensive enough to require prosthetic replacement. When there is intact glenoid cartilage, shoulder hemiarthroplasty can be successful. When there is extensive humeral head damage as well as glenoid damage, total joint arthroplasty is indicated. The patients, rather than roentgenograms, should be treated. The shoulder is a nonweight-bearing joint, and surgical treatment may be unnecessary and avoided if the patient has relatively little discomfort and reasonable function.