Cruess classification of humeral head osteonecrosis

Last revised by Jeremy Jones on 12 Mar 2023

The Cruess classification of humeral head osteonecrosis uses plain radiographs, CT and/or MRI for its staging system. Early Cruess stage osteonecrosis may only be detected on MRI.

The Cruess classification is the best-known system and is composed of five stages 1:

  • stage I: pre-radiological stage with normal radiographs but CT or MRI osseous changes present

  • stage II: osteoporosis, sclerosis, or both, or localized subchondral osteolysis without fracturing

  • stage III: subchondral fracture with mild loss of congruity and a “crescent sign”

  • stage IV: extensive collapse of subchondral bone with severe articular incongruity and secondary degenerative changes (osteochondral flaps may break free and become loose bodies)

  • stage V: stage IV humeral head changes with pathologic changes of the glenoid

In 1968, Cruess et al. published a classification of osteonecrosis of the humeral head 1.

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