Milwaukee shoulder syndrome

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Milwaukee shoulder syndrome (MSS), also known as apatite-associated destructive arthritis, is a rare and severe form of shoulder arthritis characterized by the deposition of calcium hydroxyapatite crystals in the joint. This condition primarily affects elderly women and is associated with significant joint destruction and rotator cuff tears.

Pathophysiology

Milwaukee shoulder syndrome is caused by the accumulation of calcium hydroxyapatite crystals in the shoulder joint. These crystals induce an inflammatory response, leading to the release of proteolytic enzymes that degrade the joint structures, including the articular cartilage and the rotator cuff. The resulting joint damage can lead to severe pain, reduced range of motion, and functional impairment.

Clinical Presentation

Patients with Milwaukee shoulder syndrome typically present with:

• Chronic shoulder pain
• Swelling and warmth over the affected joint
• Limited range of motion
• Crepitus (a grating sensation) during shoulder movement

Diagnosis

The diagnosis of Milwaukee shoulder syndrome is based on clinical presentation, imaging studies, and the analysis of joint fluid. Key diagnostic tools include:

• X-ray: May show joint space narrowing, calcific deposits, and signs of joint destruction.
• Ultrasound: Can detect rotator cuff tears and the presence of calcific deposits.
• Magnetic Resonance Imaging (MRI): Provides detailed images of the soft tissues and can identify rotator cuff tears and other joint abnormalities.
• Joint fluid analysis: Reveals the presence of calcium hydroxyapatite crystals and may show elevated levels of inflammatory markers.

Treatment

The management of Milwaukee shoulder syndrome focuses on relieving symptoms and preventing further joint damage. Treatment options include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): To reduce pain and inflammation.
• Corticosteroid injections: To decrease inflammation.
• Physical therapy: To improve range of motion and strengthen the shoulder muscles.
• Surgical intervention: In severe cases, procedures such as debridement, rotator cuff repair, or shoulder replacement may be necessary.

Prognosis

The prognosis for patients with Milwaukee shoulder syndrome varies. While some patients may experience significant relief with conservative treatment, others may require surgical intervention to restore joint function. Early diagnosis and appropriate management are crucial to prevent severe joint destruction and maintain quality of life.

Related Pages

• Shoulder
• Arthritis
• Rotator cuff
• Calcium hydroxyapatite
• Nonsteroidal anti-inflammatory drugs
• Corticosteroid
• Physical therapy
• Surgery