Subchondral Insufficiency Fracture of the Humeral Head: A Rare Case in a Young Person

Subchondral insufficiency fracture (SIF) of the humeral head is rare compared to SIF of the femoral head, and most of the reported cases have been of elderly women with osteoporosis. We report a rare case of SIF of the shoulder in a man aged 32 years. Following a consultation with a local physician, the patient was referred to our hospital with worsening right shoulder pain and suspected humeral head necrosis based on magnetic resonance imaging (MRI) findings. The patient had no history of steroid or excessive alcohol consumption. The patient had a limited range of motion in the shoulder joint and decreased lumbar bone mineral density. Radiography of the right shoulder revealed collapse and deformation of the humeral head. MRI revealed a depressed fracture of the humeral head, partial thinning, and loss of articular cartilage in the glenoid cavity. He had received intra-articular injections of triamcinolone acetonide, which yielded no improvement; therefore, hemiarthroplasty and osteochondral autografting were performed. SIF was diagnosed based on the pathology of the excised head, which exhibited callus formation and granulation tissue. Two years after surgery, his range of motion and pain improved. This study demonstrates that it is important to consider SIF as a differential diagnosis for shoulder pain, even in young men.