What is Milwaukee shoulder syndrome?
Milwaukee shoulder syndrome is a rare and destructive form of arthropathy that mainly affects elderly women. It is characterised by intra-articular or periarticular hydroxyapatite crystals and rapid destruction of the rotator cuff and the glenohumeral joint.
What does rotator cuff arthropathy mean?
Rotator cuff tear arthropathy (arthritis with a massive rotator cuff tear) is a devastating condition that seriously compromises the comfort and function of the shoulder. This condition is characterized by the permanent loss of the rotator cuff tendons and the normal surface of the shoulder joint.
Can you lift your arm with a rotator cuff tear?
A partial or complete rotator cuff tear makes it difficult to raise and move your arm. You may have shoulder pain and arm weakness.
Is rotator cuff syndrome arthritis?
Rotator cuff tear arthropathy is a type of shoulder arthritis that can develop after a massive and prolonged rotator cuff tear. The four rotator cuff tendons in your shoulder wrap around the ball portion of the shoulder joint, holding it in place.
How do you fix rotator cuff arthropathy?
Treatment options for cuff tear arthropathy include partial joint replacement with a cuff tear arthropathy (CTA) prosthesis. If severe instability of the joint complicates cuff tear arthropathy a reversed (reverse Delta) prosthesis may be indicated.
Is arthritis and arthropathy the same?
Arthropathy is a joint disease, of which arthritis is a type. Arthropathies can be associated with a hematologic (blood) disorder or an infection, such as Lyme disease.
How common is rotator cuff arthropathy?
Rotator cuff injuries are remarkably common. Around 2 million Americans a year go to their doctor because of this painful shoulder condition. However, a simple rotator cuff injury can develop into a more complicated condition called rotator cuff arthropathy, where severe arthritis sets in at the location of the tear.
What happens if rotator cuff is not repaired?
Without any treatment—either rest and rehabilitation or surgery—rotator cuff disorders may get worse. Over time, you may have more pain. You may lose range of motion and strength in your shoulder, making it harder to do your daily activities.
What is Milwaukee shoulder syndrome?
Milwaukee shoulder syndrome (MSS) is a rare destructive, calcium phosphate crystalline arthropathy. It encompasses an effusion that is noninflammatory with numerous aggregates of calcium hydroxyapatite crystals in the synovial fluid, associated with rotator cuff defects. We describe a patient that presented with recurrent shoulder pain ...
When was MSS first used?
The term Milwaukee shoulder syndrome (MSS) was first used in 1981 to describe four elderly women in Milwaukee in the state of Wisconsin, USA, with recurrent bilateral shoulder effusions, radiographic evidence of severe destructive changes of the glenohumeral joints, and massive tears of the rotator cuff [ 1.
Is MSS a rare cause of swollen joints?
This case was a rare cause of an acutely swollen joint. The patient presented with recurrent shoulder pain and swelling with characteristic radiographic changes and MSS was confirmed on aspiration of the synovial fluid. She responded well to conservative management. This case highlights the importance of considering calcium hydroxyapatite crystal arthropathy as a potential cause for sudden onset monoarthritis.
How does Milwaukee shoulder syndrome (apatite-associated arthropathy, rotator cuff tear arthropathy, or BCP-associated destructive arthropathy) present?
Milwaukee shoulder syndrome is a severe destructive arthritis of the glenohumeral joint with loss of the rotator cuff associated with the presence of BCP crystals. It affects mostly elderly women and is usually bilateral.
How is Milwaukee shoulder syndrome treated?
Treatment options are limited, and treatment choice is primarily dictated by severity of symptoms. Some patients with mild symptoms do well with daily NSAIDs and/or analgesics. Local heat can be beneficial. If large effusions are present, repeated arthrocentesis may relieve symptoms.
Abstract
Case
- An 89-year-old lady presented to the medical assessment unit with a four-day history of melaena associated with shortness of breath on exertion, postural dizziness, and lethargy. This was secondary to esophagitis and gastric erosions. During her hospital stay she developed a rapid onset, painful swelling of her right shoulder with a limited range of movement. There was no hist…
Discussion
- The term Milwaukee shoulder syndrome (MSS) was first used in 1981 to describe four elderly women in Milwaukee in the state of Wisconsin, USA, with recurrent bilateral shoulder effusions, radiographic evidence of severe destructive changes of the glenohumeral joints, and massive tears of the rotator cuff [ 1. J. C. Garancis, H. S. Cheung, P. B. Halv...
Learning Point
- The learning point is to increase awareness of a rare cause of an acutely swollen joint. MSS is a destructive, calcium phosphate crystalline arthropathy; it encompasses an effusion that is noninflammatory with numerous aggregates of calcium hydroxyapatite crystals in the synovial fluid, associated with rotator cuff defects.
Disclosure
- The contents of this paper have not been otherwise copyrighted. The contents of this paper are not under consideration for publication elsewhere. This case was presented as a poster at the Society of Acute Medicine meeting in October 2012. This research/project received no specific grant from any funding agency in the public commercial or not-for-profit sectors.
Authors’ Contribution
- All authors of this paper have directly participated in the planning, execution, and write-up of this study. All authors of this paper have read and approved the final version submitted.
Acknowledgments
- The authors would like to express their gratitude to Dr. Gaya Thanabalasingham and Mrs. Lisa Longval Weichert for their support in publishing this paper.