Background Avascular necrosis of the humeral head (AVNHH), a pathologic process with multifactorial etiology that results from interruption of blood supply to the bone, leading to the collapse of humeral head that requires shoulder hemiarthroplasty, is the second most common site of this disorder behind the femoral head. Trauma is a common cause, but atraumatic necrosis has developed for patient with risk factors. The successful treatment is related directly to the stage of disease at diagnosis. Early detection and conservative treatment with physical therapy, modification of activity, kinetic program and analgesics is the key to best management.
Objectives The objectives of our study (a single blind, randomized controlled trial) were: to establish the risk factors associated with disease and to evaluate the effect of rehabilitation program on clinical and functional parameters and to assess the short-term effects of this program on quality of life of patients with AVNHH.
Methods 12 patients aged between 35 - 45 years with AVNHH stage I and II (precollapse stages), were randomized into two groups: Group 1 – 7 patients (G1) was treated by complex therapy (medication, stretching and strengthening exercises, ultrasound and interferential current), and group 2 – 5 patients (G2) control receiving only medication. The duration of rehabilitation program was 4 weeks. All patients were evaluated initial and finally. The outcome assessments at the beginning and at the end of the rehabilitation were pain intensity (with dolorimeter), active range of shoulder movements and HAQ score.
Results The AVNHH is associated with shoulder traumatic conditions (5 patients) and the mentioned risk factors were corticosteroid administration (10 patients), heavy alcohol intake (4 patients), rheumatoid arthritis (3 patients).
In both groups, improvements were found in pain intensity (65% in G1 and 35% in G 2, respectively) and this reduction was significantly higher in G1. The mean value of range of shoulder movements (flexion, abduction, rotations) and HAQ score showed significant improvements in G1 group.
Conclusions Our study confirms the literature data that rehabilitation program can be very effective in treating AVNHH if it is detected early. Maintaining range of motion and muscle strength are crucial to avoid further humeral head collapse and improvement in pain scores and upper limb function.
Disclosure of Interest None declared