This is a patient who presented with progressively worsening shoulder pain. Radiographs of the shoulder were obtained. The first radiograph demonstrates sclerosis of the humeral head consistent with osteonecrosis. The second image nicely demonstrates subcortical lucency consistent with collapse of the articular surface of the humeral head. There are marginal osteophytes on the humeral head with narrowing of the glenohumeral joint space consistent with secondary osteoarthrosis. This disease process is progressive over time with patients eventually requiring a shoulder replacement.