While much literature has focused on the management of osteonecrosis of the femoral head, far less information is available regarding the treatment and outcomes of this disease in the proximal humerus. To a great extent, management of humeral head osteonecrosis has been inferred from studies involving the femoral head. The etiologies for this disease can be categorized most usefully as traumatic versus atraumatic. Regardless of the underlying etiology, the common pathway involves disruption of the arterial inflow or the venous outflow of the bone, with resultant osseous cell death. The general treatment strategies for humeral head osteonecrosis include nonoperative modalities for symptomatic early disease, with surgical intervention reserved for more advanced disease or those with recalcitrant pain.