Cruess classification of humeral head osteonecrosis
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- updated 16 Jan 2023:
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Cruess classification of osteonecrosis of humeral head osteonecrosis
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Plain radiography is effective in evaluating bone pathologyThe Cruess classification of humeral head osteonecrosis uses plain radiographs, and CT and/or MRI for its staging system. However, the preradiographic earlyEarly Cruess stage osteonecrosis may only be lackingdetected on MRI.MRI
Classification
The Cruess classification is useful for detecting early AVN and for staging with the best known system, that of Cruess, and is composed of five phases.stages 1:
Stagestage I:preradiologicpre-radiological stage with normal radiographs butboneCT or MRI osseous changes presentStagestage II: osteoporosis, sclerosis or both, or localised subchondral osteolysis without fracturingStagestage III: subchondral fracture with mild loss of congruity and “crescent sign”Stagestage IV: extensive collapse of subchondral bone with severe articular incongruity and secondary degenerative changesStagestage V: stage4IV humeral head changesplus pathologic changes of the glenoid
History and etymology
In 1968, Cruess et al. publish a classification of osteonecrosis of the shoulder1.
See also
-<p>Plain radiography is effective in evaluating bone pathology. However, the preradiographic early stage of <a href="/articles/osteonecrosis-of-the-humeral-head" title="AVN of the humeral head">AVN </a>may be lacking. <a href="/articles/mri-2" title="MRI">MRI</a> is useful for detecting early AVN and for staging with the best known system, that of Cruess, composed of five phases.</p><p><strong>Stage I</strong> : preradiologic stage with normal radiographs but bone CT or MRI changes present</p><p><strong>Stage II</strong> : osteoporosis, sclerosis or both or localised subchondral osteolysis without fracturing</p><p><strong>Stage III</strong> : subchondral fracture with mild loss of congruity and <a href="/articles/crescent-sign-of-arterial-dissection" title="“crescent sign”">“crescent sign”</a></p><p><strong>Stage IV</strong> : extensive collapse of subchondral bone with severe articular incongruity and secondary degenerative changes</p><p><strong>Stage V</strong> : stage 4 humeral head changes plus pathologic changes of the glenoid</p><h4>History and etymology</h4><p>In 1968 Cruess et al. publish a classification of osteonecrosis of the shoulder</p><h4>See also</h4><p><a href="/articles/osteonecrosis-of-the-humeral-head" title="Osteonecrosis of the humeral head">Osteonecrosis of the humeral head</a></p><p><a href="/articles/total-shoulder-arthroplasty-1" title="Total shoulder arthroplasty">Total shoulder arthroplasty</a></p>- +<p>The <strong>Cruess classification of humeral head osteonecrosis</strong> uses plain radiographs, and CT and/or MRI for its staging system. Early Cruess stage <a href="/articles/osteonecrosis-2" title="Osteonecrosis">osteonecrosis</a> may only be detected on MRI.</p><h4>Classification</h4><p>The Cruess classification is the best known system and is composed of five stages <sup>1</sup>:</p><ul>
- +<li><p><strong>stage I</strong>: pre-radiological stage with normal radiographs but CT or MRI osseous changes present</p></li>
- +<li><p><strong>stage II</strong>: osteoporosis, sclerosis or both, or localised subchondral osteolysis without fracturing</p></li>
- +<li><p><strong>stage III</strong>: subchondral fracture with mild loss of congruity and <a href="/articles/crescent-sign-of-arterial-dissection" title="“crescent sign”">“crescent sign”</a></p></li>
- +<li><p><strong>stage IV</strong>: extensive collapse of subchondral bone with severe articular incongruity and secondary degenerative changes</p></li>
- +<li><p><strong>stage V</strong>: stage IV humeral head changes plus pathologic changes of the glenoid</p></li>
- +</ul><h4>History and etymology</h4><p>In 1968, <strong>Cruess </strong>et al. publish a classification of osteonecrosis of the shoulder <sup>1</sup>.</p><h4>See also</h4><ul>
- +<li><p><a href="/articles/osteonecrosis-of-the-humeral-head" title="Osteonecrosis of the humeral head">osteonecrosis of the humeral head</a></p></li>
- +<li><p><a href="/articles/total-shoulder-arthroplasty-1" title="Total shoulder arthroplasty">total shoulder arthroplasty</a></p></li>
- +</ul>
References changed:
- 1. Hernigou P, Hernigou J, Scarlat M. Shoulder Osteonecrosis: Pathogenesis, Causes, Clinical Evaluation, Imaging, and Classification. Orthop Surg. 2020;12(5):1340-9. <a href="https://doi.org/10.1111/os.12788">doi:10.1111/os.12788</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/33015963">Pubmed</a>
- Orthop Surg. 2020 Oct; 12(5): 1340–1349. Published online 2020 Oct 4. doi: 10.1111/os.12788 PMCID: PMC7670135 PMID: 33015963 Philippe Hernigou, MD, 1 Jacques Hernigou, MD, 2 and Marius Scarlat, MD 3
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