PMC6457295_01
Clinical examination revealed no gross deformities or muscle atrophy on the left shoulder comparative to the contralateral upper limb. The range of motion of the left shoulder was preserved with functional shoulder symmetry. (a) Neutral position. (b) Internal rotation. (c) External rotation. (d) Abduction to 90 degrees. (e) Abduction to 180 degrees.
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The range of motion of the left shoulder was well preserved with functional shoulder symmetry (Figure 1).
Radiographs of the left shoulder demonstrated abnormal morphology of the left humerus head, characterized by a large anteromedial exostosis arising from the epiphysis of this bone. The initial diagnosis was DEH. In addition, slight proximal migration of the distal part of the left clavicle was noted (Rockwood and Neer grade 2 AC dislocation), with no signs of AC degenerative disease. (a) True AP view and (b) AP view with maximal internal rotation.
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In addition, there were no signs of AC disease, although there was slight proximal migration of the distal part of the left clavicle, compatible with a Rockwood and Neer grade 2 AC dislocation (Figure 2).
Coronal CT showed an ossified mass in the inferomedial aspect of the proximal humerus epiphysis with no articular or soft tissue involvement. The lesion was very characteristic of DEH and it was classified as extra-articular type B1 (affecting the upper limb, localized to a single bone), according to Clarke's classification system.
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CT showed an ossified mass in the inferomedial aspect of the proximal humerus epiphysis with no articular or soft tissue involvement (Figure 3).
MR images of the left shoulder revealed the inferomedial mass projecting toward the inferior capsular recess, with sharpening of the articular cartilage of the humeral head, but no signs of OA. Cartilaginous components of the tumor showed intermediate T1-weigthed signal and hyperintense proton density- (PD-) weighted signal. In contrast, bone marrow of the tumor showed hyperintense T1-weighted signal and intermediate-to-low PD-weighted signal. (a) T1-weigthed coronal image, (b) PD-weighted coronal image, and (c) and (d) T2-weigthed axial images.
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No foci of calcification or soft tissue involvement was noted (Figure 4).