Core Decompression for Class I Avascular Necrosis of Humeral Head

Abstract

Avascular necrosis of the humeral head is a diagnosis of multiple etiologies and unclear prognosis. Prompt diagnosis and treatment are essential to prevent head collapse and avoid resurfacing or joint replacement procedures. Imaging modalities including standard radiography and magnetic resonance imaging establish the diagnosis and stage it according to the degree of necrosis, head collapse, or extension into the glenoid. If the patient stays persistently symptomatic despite conservative treatments and is still in the early stages of the disease course, humeral head core decompression is a reasonable option as it has been shown to decrease disease progression and provide symptomatic relief. Here, we present a case of a 52-year-old female with a history of adhesive capsulitis status postmanipulation and arthroscopic lysis of adhesions, now presenting with Cruess Stage I avascular necrosis of the humeral head. This technique (Supplemental Video, Supplemental Digital Content 1, https://links.lww.com/TSES/A36) demonstrates core decompression and grafting of the humeral head using a percutaneous expandable reamer.

Level of Evidence: Level V (expert opinion).