[Rapid destructive arthropathy of the shoulder]

Abstract

Within the general context of rapid destruction of the humeral head, destructive arthropathy of the shoulder, described here in six cases, is a diagnosis of elimination. Being neither infectious inflammatory, microcrystalline, nor neurological, this curious variety of degenerative pathology of the shoulder involves the following: 1) a particular group of sufferers: women aged 65 to 81 years; 2) prior signs, at least radiological, of deterioration in the rotator cuff; 3) rapid erosive osteolysis of the head of the humerus reducing its radiological area by 25 per cent in less than six months; 4) early narrowing of the scapulo-humeral joint space (Ist to 9th month); 5) transient appearance of calcium debris in the area of the joint; 6) a synovial effusion in some cases, often bloody. The destruction phase is associated with pain lasting from two months to two years. However at the stage of stable sequelae, pain is moderate or minimal. Differential diagnosis with destructive arthropathy due to articular chondrocalcinosis and necrosis of the head of the humerus is particularly discussed. The cause of rapid destruction is unknown. It may be multifactorial: advanced age (constant), osteoporosis, fragility of articular cartilage as evidenced by multiple localizations of osteoarthrosis (4 cases out of 6), enzymes in the bloody effusion, trauma (3 cases out of 7), and intra-articular injections of corticosteroid derivatives, in particular fluorinated (3 cases out of 7) may possibly play a role.