A 66-year-old woman with idiopathic chronic renal failure was admitted to our clinic for shoulder pain. Physical examination revealed a tender left shoulder with limitation of active and preservation of passive motion. Previous radiographic evaluation of the left shoulder revealed subchondral cystic lesions in the humeral head and, mild degenerative changes were detected by magnetic resonance imaging (MRI). Two intra-articular injections of methylprednisolone acetate 40 mg were administered to her shoulder at a four-month interval. Due to persistent shoulder pain, MRI of the shoulder was repeated and osteonecrosis of the humeral head was depicted. Osteonecrosis is a recognized complication of chronic renal failure in association with kidney transplantation or steroid therapy. Turk J Phys Med Rehab 2011;57:101-3.