ABNORMALITIES OF THE ADULT SHOULDER DUE TO SICKLE-CELL OSTEONECROSIS DURING CHILDHOOD

Patients and methods. A retrospective study of 110 adults with sickle cell anemia (SS genotype) was conducted to determine the frequency of complications of sickle cell osteonecrosis of the shoulder in childhoo d. The glenohumeral joint was evaluated on plain anteroposterior and l ateral radiographs of the shoulder. Results. Mean time since osteonecr osis of the shoulder was 24 years. Radiographic abnormalities mere see n in 106 of the 220 shoulders (48.2 %). Both shoulders were affected i n 86 % of cases and at least one hip in 96 %. Radiographic abnormaliti es included isolated caput magna, caput plana, a short humeral neck an d ascension of the tuberosities. Twelve shoulders exhibited glenoid fo ssa abnormalities, which consisted in complete or partial hypoplasia. Evidence of glenohumeral osteoarthritis was seen in 11 shoulders. Disc ussion. The shoulder abnormalities seen in our patients were probably due to growth disturbances in the proximal humerus secondary to osteon ecrosis of the humeral head during childhood. They were common but les s likely to produce functional impairment than osteonecrosis-related l esions of the hip. However, some patients had premature osteoarthritis and geometric shoulder abnormalities responsible for functional loss in adulthood.