肩関節に発生した急速破壊型関節症の1例

Rapidly Destructive Arthritis of the Shoulder. Case Report

　肩関節に発生した急速破壊型関節症の1例を報告する．症例は74歳の女性で，7年前から左肩関節痛が出現し，近医で保存加療を受けていた．来院時，疼痛が強く，画像所見で骨頭圧潰，臼蓋側の骨欠損を認めた．前医の画像では5カ月間で急速に骨頭圧潰が進行しており，急速破壊型関節症と診断した．著明な関節破壊を認めたが，腱板は保たれていたため，治療は人工肩関節置換術を施行した．肩関節での急速破壊型関節症は稀な疾患であり，高齢女性に多く著明な関節水腫を特徴とする．本症例における病因は骨粗鬆症とoveruseに伴う軟骨下不顕性骨折(subchondral insufficiency fracture)が関与したのではと推察した．

　We report a case of rapidly destructive arthritis of the shoulder.　The patient was a 74-year-old woman with a 7-year history of left shoulder pain.　She had been treated conservatively by intra-articular injections at local hospital.　When she came to our hospital, she complained of great pain.　Radiography and computed tomography showed broken on the left humeral head and defect in the rim of the glenoid fossa.　Since the radiographs from the previous hospital showed that destruction of the shoulder had progressed in just 5 months, we made a diagnosis of rapidly destructive arthritis of the shoulder, and we performed total shoulder arthroplasty (TSA), because the rotator cuff was intact.　Destructive arthritis of the shoulder is a rare disease that usually occurs to older women and is characterized by repeated joint effusion.　We suspected that the etiology of this disease was osteoporosis and a subchondral insufficiency fracture due to overuse.