Shoulder Osteonecrosis After Pregnancy

Autor: Ana María Benavente Valdepeñas, Ramiro Palazón García, María Isabel Monge Berruezo, Patricia Acal Gutiérrez
Rok vydání: 2007
Předmět:
Zdroj: Reumatología Clínica (English Edition). 3:137-138
ISSN: 2173-5743
Popis: A 38-year-old woman without any history of interest was sent to the rehabilitation outpatient clinic due to left shoulder pain lasting 6 months and that started 2 months after the delivery of her second child. The patient reported that pain increased when elevating her left arm and sleeping on her left shoulder. The patient stated that after her first pregnancy, 2 years prior, she also presented a limitation in the mobility of her left shoulder that improved after infiltration and range of motion exercise, recovering full movement after 2 months. Examination showed deltoid, trapezium, and rhomboid atrophy. The articular balance of the left shoulder upon active movement was: flexion, 100o; abduction, 90o; anterior movement, reaching the posterior neck; posterior movement, reaching the hips; and general muscle strength, 3/5. Blood count, chemistry, and immunologic studies were all normal, including antistreptolysins, ESR, PCR, RF, thyroidal hormones, antinuclear antibodies, and antiphospholipid antibodies. On x-ray (anteroposterior and axial projections), done at 4 months since onset there was evident deformity and sclerosis of the left humeral head (Figure 1). At 6 months since onset she underwent an MRI (sagital and coronal planes with SE T1, coronal T2 with fat suppression, and axial T2), in which a border irregularity of the humeral head and the glenoid cavity can be seen, as well as subchondral cysts and a general reduction in the joint cartilage height (Figure 2). A radionuclide scan with tecnesium-99, done after 9 months showed, on early vascular phase, a discreet reinforcement of uptake on the left shoulder and a late bone phase with a marked deposit upon uptake in a diffuse manner on the left humeral head, although with a focal deposit that was markedly increased medially (Figure 3) and that on the electromyography did not show any lesion of the accessory spinal or circumflex nerves. Shoulder Osteonecrosis After Pregnancy
Databáze: OpenAIRE
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