J Rheum Dis.  2019 Apr;26(2):142-146. 10.4078/jrd.2019.26.2.142.

Very Rapidly Progressive Shoulder Arthropathy with Complete Destruction of the Humeral Head

Affiliations
  • 1Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea.
  • 2Department of Orthopedic Surgery, Jeju National University School of Medicine, Jeju, Korea. swchoi1115@gmail.com, oskanghs@gmail.com

Abstract

Milwaukee shoulder syndrome (MSS) is a rare disease in which joints are destroyed and occurs mainly in elderly women. We describe rapidly progressive MSS with complete destruction of the shoulder joint within 2 months. An 80-year-old woman visited the outpatient clinic with shoulder pain for 2 weeks. rotator cuff tear arthropathy was diagnosed, and nonsteroidal anti-inflammatory drugs were prescribed. Two months later, her shoulder pain worsened without trauma. Shoulder swelling and tenderness, and arm lifting inability were observed. Complete humeral head disruption was observed by radiography. We diagnosed MSS based on the presence of serohematic and noninflammatory joint effusion, periarticular calcific deposits, and rapid joint destruction, and initiated conservative treatment. When initially treating elderly patients with shoulder arthropathy, it is advisable to perform short-term follow-up and to consider the possibility of crystal-induced arthropathy.

Keyword

Milwaukee shoulder syndrome; Rotator cuff tear arthropathy

MeSH Terms

Aged
Aged, 80 and over
Ambulatory Care Facilities
Arm
Female
Follow-Up Studies
Humans
Humeral Head*
Joints
Lifting
Radiography
Rare Diseases
Rotator Cuff
Shoulder Joint
Shoulder Pain
Shoulder*
Tears

Figure

  • Figure 1 (A) At first visit, the radiograph shows subacromial space narrowing and upward migration of humeral head, at the first visit. (B) Two months later, the radiograph shows extensive soft tissue swelling with extensive amorphous calcifications, complete destruction of the humeral head with cephalic migration, joint space narrowing, and erosion of the glenoid.

  • Figure 2 Computed tomography shows complete destruction of the humeral head and erosion of the glenoid.

  • Figure 3 Magnetic resonance imaging shows a large amount of fluid collection (red arrows) and bone debris (blue arrows) in the glenohumeral joint, total collapse of the humeral head and neck (white arrows) and glenoid (green arrow) of scapula and tears of the rotator cuff and rupture of biceps tendon (yellow arrows).

  • Figure 4 Two years later, radiograph shows a deformed humeral head, disappeared large amount of amorphous calcification and decreased soft tissue swelling.


Reference

1. McCarty DJ. Milwaukee shoulder syndrome. Trans Am Clin Climatol Assoc. 1991; 102:271–283.
2. McCarty DJ, Halverson PB, Carrera GF, Brewer BJ, Kozin F. “Milwaukee shoulder”--association of microspheroids containing hydroxyapatite crystals, active collagenase, and neutral protease with rotator cuff defects. I. Clinical aspects. Arthritis Rheum. 1981; 24:464–473.
Article
3. Rood MJ, van Laar JM, de Schepper AM, Huizinga TW. The Milwaukee shoulder/knee syndrome. J Clin Rheumatol. 2008; 14:249–250.
Article
4. Santiago T, Coutinho M, Malcata A, da Silva JA. Milwaukee shoulder (and knee) syndrome. BMJ Case Rep. 2014; 2014:pii: bcr2013202183.
Article
5. Nadarajah CV, Weichert I. Milwaukee shoulder syndrome. Case Rep Rheumatol. 2014; 2014:458708.
Article
6. Forster CJ, Oglesby RJ, Szkutnik AJ, Roberts JR. Positive alizarin red clumps in Milwaukee shoulder syndrome. J Rheumatol. 2009; 36:2853.
Article
7. Llauger J, Palmer J, Rosón N, Bagué S, Camins A, Cremades R. Nonseptic monoarthritis: imaging features with clinical and histopathologic correlation. Radiographics. 2000; 20 Spec No:S263–S278.
Article
8. Sahinbegovic E, Dallos T, Aigner E, Axmann R, Manger B, Englbrecht M, et al. Musculoskeletal disease burden of hereditary hemochromatosis. Arthritis Rheum. 2010; 62:3792–3798.
Article
9. Romijn JA. Acromegalic arthropathy: current perspectives. Endocrine. 2013; 43:245–246.
Article
10. Takeuchi A, Yamamoto N, Hayashi K, Miwa S, Takahira M, Fukui K, et al. Tenosynovial giant cell tumors in unusual locations detected by positron emission tomography imaging confused with malignant tumors: report of two cases. BMC Musculoskelet Disord. 2016; 17:180.
Article
11. Wakhlu A, Wakhlu A, Tandon V, Krishnani N. “Smouldering conditions of the shoulder” lest we forget. Indian J Rheumatol. 2017; 12:169–174.
Article
12. Su J, Al-Delfi F, Mills G, Peddi P. Charcot's osteoarthropathy mimicking an osteosarcoma of humerus. BMJ Case Rep. 2016; 2016:pii: bcr2015212638.
Article
13. Rowe IF. Amyloid arthropathy. Ann Rheum Dis. 1985; 44:727–728.
Article
14. Paul H, Reginato AJ, Schumacher HR. Alizarin red S staining as a screening test to detect calcium compounds in synovial fluid. Arthritis Rheum. 1983; 26:191–200.
Article
Full Text Links
  • JRD
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr