WORLD JOURNAL OF ADVANCE
HEALTHCARE RESEARCH

*Dr. Khaldoon H. Qasim, Dr. Mubder A. Mohammed Saeed, Dr. Basim Abdulkareem Abdulhassan Alhijaj

ABSTRACT

Background: Sickle cell disease is a common hemoglobinopathy in Iraq generally and Basrah specifically. It is associated with various musculoskeletal complications, particularly avascular necrosis of the hip and the shoulder joints. Although avascular necrosis is a known complication of sickle cell disease, data specifically addressing humeral-head involvement are limited. Objectives: To determine the prevalence, clinical features, radiological findings, and outcomes of shoulder avascular necrosis in patients with sickle cell disease presenting with shoulder pain in Basrah city. Methods: A Randomised prospective observational cohort study with baseline cross-sectional assessment conducted on 102 sickler patients with shoulder pain attending the Basrah Hereditary blood disease Center, Al-Sayyab Teaching Hospital and Basrah Teaching Hospital (joint arthroplasty center) from (April 2024 to May 2025). All patients underwent clinical evaluation, radiography, and selective computed scan and magnetic resounce imaging. Pain severity was assessed using the Visual Analog Scale, shoulder function was evaluated with Oxford shoulder score OSS (the old version), and functional outcomes were documented. Results: Avascular necrosis of the shoulder was identified in 21 patients (20.6%). The radiological staging shown by magnetic resonance imaging revealed 4 (19.04%) in stage I, 6 (28.57%) in stage II, 8 (38.09%) in stage III, and 3 (14.28%) in stage IV. Moreover, avascular necrosis was significantly associated with chronic pain (>1 month), severe pain (Visual Analog Scale 7–10), low Oxford scores, tenderness, muscle wasting, deformity, and limited movement (p value < 0.01). Additionally, sclerosis and humeral head collapse were prominent radiographic findings. At follow-up, of non- avascular necrosis patients 95.1% showed improvement in pain and function, compared to only 38.1% of avascular necrosis patients, worsening of symptoms occurring exclusively in the avascular necrosis group (23.8%). Lastly, rehospitalisation for vaso-occlusive crisis was also more frequent in avascular necrosis patients (95.2% versus 53.1%; p value = 0.001). Conclusions: Shoulder avascular necrosis is a frequent and disabling complication of sickle cell disease in Basrah. It is associated with distinct clinical and radiological features, prolonged pain, severe functional impairment, and poorer prognosis compared to Vasooclussive crisis-related shoulder pain. Early recognition through radiology and magnetic resonance imaging, combined with timely intervention, is essential to reduce morbidity and improve quality of life.