Shoulder:Glenohumeral Arthritis/Milwaukee shoulder - Revision history

Alexandre.laedermann: /* Introduction */

2021-08-15T11:27:23Z

Introduction

Alexandre.laedermann at 11:22, 15 August 2021

2021-08-15T11:22:15Z

Alexandre.laedermann: /* Discussion */

2021-08-15T11:17:03Z

Discussion

Alexandre.laedermann: /* Magnetic Resonance Imaging */

2021-08-15T11:16:37Z

Magnetic Resonance Imaging

Alexandre.laedermann: /* Imaging */

2021-08-15T11:15:58Z

Imaging

Alexandre.laedermann: /* History[edit | edit source] */

2021-08-15T10:54:05Z

History[edit | edit source]

Alexandre.laedermann: /* History[edit | edit source] */

2021-08-15T10:49:17Z

History[edit | edit source]

Alexandre.laedermann: /* History[edit | edit source] */

2021-08-15T10:48:40Z

History[edit | edit source]

Alexandre.laedermann: /* History[edit | edit source] */

2021-08-15T10:47:02Z

History[edit | edit source]

Alexandre.laedermann: /* History[edit | edit source] */

2021-08-15T10:44:46Z

History[edit | edit source]

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 ==Introduction==
-Milwaukee shoulder syndrome (apatite-associated destructive arthritis) is a rheumatological condition similar to calcium pyrophosphate dihydrate deposition disease. It is associated with periarticular or intra-articular deposition of hydroxyapatite crystals. Crystal deposition in the joint causes the release of collagenases, serine proteases, elastases, and interleukin-1. This precipitates acute and rapid decline in joint function and degradation of joint anatomy. Subsequently disruption of the rotator cuff ensues.<ref>[https://archive.is/20120223034722/http://www.medcyclopaedia.com/library/topics/volume_iii_1/m/milwaukee_shoulder_syndrome/gmilwaukee_shoulder_syn_fig01.aspx Milwaukee Shoulder Syndrome], Medcyclopedia (with image), via archive.org. Accessed 2013-1-27.</ref><ref>Genta MS, Gambay C. Milwaukee Shoulder. New England Journal of Medicine. 2006;354:2</ref> Along with symptomatology, the disease typically presents with positive [[Radiology|radiologic]] findings, often showing marked erosion of the [[Upper extremity of humerus|humeral head]], [[cartilage]], [[Articular capsule|capsule]], and [[Bursitis|bursae]]. Though rare, it is most often seen in females beginning in their 50s or 60s. Diagnosis is made with [[arthrocentesis]] and [[Alizarin|Alizarin Red staining]] along with clinical symptoms.<ref>Epis O, Viola E, Bruschi E, Benazzo F, Montecucco C.Reumatismo. 2005 Apr-Jun;57(2):69-77</ref>
+Milwaukee shoulder syndrome (apatite-associated destructive arthritis) is a rheumatological condition similar to calcium pyrophosphate dihydrate deposition disease. It is associated with periarticular or intra-articular deposition of hydroxyapatite crystals. Crystal deposition in the joint causes the release of collagenases, serine proteases, elastases, and interleukin-1. This precipitates acute and rapid decline in joint function and degradation of joint anatomy. Subsequently disruption of the rotator cuff ensues.<ref>[https://archive.is/20120223034722/http://www.medcyclopaedia.com/library/topics/volume_iii_1/m/milwaukee_shoulder_syndrome/gmilwaukee_shoulder_syn_fig01.aspx Milwaukee Shoulder Syndrome], Medcyclopedia (with image), via archive.org. Accessed 2013-1-27.</ref><ref>Genta MS, Gambay C. Milwaukee Shoulder. New England Journal of Medicine. 2006;354:2</ref> Along with symptomatology, the disease typically presents with positive [[Radiology|radiologic]] findings, often showing marked erosion of the humeral head, cartilage, capsule, and bursae. Though rare, it is most often seen in females beginning in their 50s or 60s. Diagnosis is made with arthrocentesis and Alizarin Red staining along with clinical symptoms.<ref>Epis O, Viola E, Bruschi E, Benazzo F, Montecucco C.Reumatismo. 2005;57(2):69-77</ref>
 ==Clinical Presentation==

@@ Line 13: / Line 13: @@
 ==Introduction==
-Milwaukee Shoulder refers to a destructive shoulder arthropathy due to the deposition of hydroxyapatite crystals, and identification of these crystals in synovial fluid is the cornerstone of diagnosis.
+Milwaukee shoulder syndrome (apatite-associated destructive arthritis) is a rheumatological condition similar to calcium pyrophosphate dihydrate deposition disease. It is associated with periarticular or intra-articular deposition of hydroxyapatite crystals. Crystal deposition in the joint causes the release of collagenases, serine proteases, elastases, and interleukin-1. This precipitates acute and rapid decline in joint function and degradation of joint anatomy. Subsequently disruption of the rotator cuff ensues.<ref>[https://archive.is/20120223034722/http://www.medcyclopaedia.com/library/topics/volume_iii_1/m/milwaukee_shoulder_syndrome/gmilwaukee_shoulder_syn_fig01.aspx Milwaukee Shoulder Syndrome], Medcyclopedia (with image), via archive.org. Accessed 2013-1-27.</ref><ref>Genta MS, Gambay C. Milwaukee Shoulder. New England Journal of Medicine. 2006;354:2</ref> Along with symptomatology, the disease typically presents with positive [[Radiology|radiologic]] findings, often showing marked erosion of the [[Upper extremity of humerus|humeral head]], [[cartilage]], [[Articular capsule|capsule]], and [[Bursitis|bursae]]. Though rare, it is most often seen in females beginning in their 50s or 60s. Diagnosis is made with [[arthrocentesis]] and [[Alizarin|Alizarin Red staining]] along with clinical symptoms.<ref>Epis O, Viola E, Bruschi E, Benazzo F, Montecucco C.Reumatismo. 2005 Apr-Jun;57(2):69-77</ref>
 ==Clinical Presentation==

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 ==Discussion==
 ==References==
 <references />

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 =====Magnetic Resonance Imaging=====
-MRI findings mirror those of the plain radiographs and include:
+Magnetic Resonance Imaging findings mirror those of the plain radiographs and include:
 *large shoulder joint effusion

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 ==Clinical Presentation==
-Symptoms are usually comparatively mild, despite rapid and marked progression of radiographic features.
+Symptoms are usually mild and include deformation, swelling (Figure) or hematoma (Video). [[File:Milwalkee.png|thumb|Milwaukee shoulder syndrome is associated with intra-articular deposition of hydroxyapatite crystals and disruption of the rotator cuff. The Figure illustrates a patient with involvement of the left shoulder]][[File:Bossy épaule sénile hémorragique.mov|thumb|Hematoma related to massive rotator cuff tear.]]
 ==Imaging==
-===== Plain radiograph =====
+=====X-ray=====
-Radiographic findings are striking and almost resembles a neuropathic joint, with advanced articular surface destruction with intra-articular loose bodies, subchondral sclerosis, soft tissue swelling and rotator cuff disruption. Cases often demonstrate superior subluxation of the humeral head in relation to the glenoid fossa 4. The superior subluxation can also result in pseudoarthrosis with the distal clavicle and/or acromion 7.
+Radiographic findings are striking and almost resembles a neuropathic joint, with advanced articular surface destruction with intra-articular loose bodies, subchondral sclerosis, soft tissue swelling and rotator cuff disruption. Cases often demonstrate superior subluxation of the humeral head in relation to the glenoid fossa. The superior subluxation can also result in pseudoarthrosis with the distal clavicle and/or acromion.
-===== MRI =====
+=====Magnetic Resonance Imaging=====
 MRI findings mirror those of the plain radiographs and include:
-* large shoulder joint effusion
+*large shoulder joint effusion
-* complete rotator cuff tear
+*complete rotator cuff tear
-* narrowing of the glenohumeral joint
+*narrowing of the glenohumeral joint
-* thinning of cartilage
+*thinning of cartilage
-* destruction of subchondral bone
+*destruction of subchondral bone
-Postoperatively, the arm is immobilized in an adjusted abduction brace for 6 to 12 weeks. Then, the splint is removed and scapulothoracic motion is allowed. Strengthening is not allowed before 12 weeks, and full activity is allowed when radiographic healing is observed.
+<br />
 ==Discussion==

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 ==History[edit | edit source]==
-Dr Robert Adams (1791 -1875) was an Irish surgeon and was three times President of the Royal College of Surgeons in Ireland, in 1840, 1860 and 1867. He first described this pathology in his own textbook published in 1857.<ref>Adams, Robert. A treatise on rheumatic gout, or chronic rheumatic arthritis of all the joints. John Churchill. London, 1957</ref> In 1981, a group of Milwaukee based researchers encountered four cases of rotator cuff loss, shoulder arthropathy and joint effusions containing calcium phosphate crystals and hence coined the term  'Milwaukee shoulder'.</ref>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 & Rheumatism. 1981;24(3):464</ref>
+Dr Robert Adams (1791 -1875) was an Irish surgeon and was three times President of the Royal College of Surgeons in Ireland, in 1840, 1860 and 1867. He first described this pathology in his own textbook published in 1857.<ref>Adams, Robert. A treatise on rheumatic gout, or chronic rheumatic arthritis of all the joints. John Churchill. London, 1957</ref> In 1981, a group of Milwaukee based researchers encountered four cases of rotator cuff loss, shoulder arthropathy and joint effusions containing calcium phosphate crystals and hence coined the term  'Milwaukee shoulder'.<ref>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 & Rheumatism. 1981;24(3):464</ref>
 ==Anecdotes[edit | edit source]==
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 ==Introduction==
-Glenohumeral arthrodesis used to be a favored surgical treatment option for patients with paralysis of the shoulder due to an underlying neurological pathology, massive rotator cuff tears, fracture sequelae, chronic instability, osteoarthritis, rheumatoid arthritis and infection.<ref>Charnley J. Compression arthrodesis of the ankle and shoulder. J Bone Joint Surg Br 1951;33B(2):180-91</ref><ref name=":0">Cofield RH, Briggs BT. Glenohumeral arthrodesis. Operative and long-term functional results. J Bone Joint Surg Am. 1979;61(5):668-77.</ref>
+Milwaukee Shoulder refers to a destructive shoulder arthropathy due to the deposition of hydroxyapatite crystals, and identification of these crystals in synovial fluid is the cornerstone of diagnosis.
-==Biomechanics==
+==Clinical Presentation==
-==Treatment==
+==Imaging==
-[[File:Diapositive4.jpg|alt=Intraoperative photo of a right shoulder. Prior to O-arm navigation a fixed reference with reflective markers spheres is placed on the spine of the scapula.|thumb|Intraoperative photo of a right shoulder. Prior to O-arm navigation a fixed reference with reflective markers spheres is placed on the spine of the scapula. Reproduced with permission from Lädermann et al.<ref name=":1" />]]
+===== Plain radiograph =====
-[[File:Diapositive5.jpg|thumb|Photo demonstrates acquisition of an intraoperative computed tomography scan obtained with an O-arm. The scan is used to to plan the position of the screws. Reproduced with permission from Lädermann et al.<ref name=":1" />]]
+===== MRI =====
-[[File:Diapositive6.jpg|thumb|Photo demonstrates placement of guide wires in the glenohumeral joint (A) with the guidance of intraoperative computer-assisted navigation (B).Reproduced with permission from Lädermann et al.<ref name=":1" />]]
+* large shoulder joint effusion
-<br />
+* complete rotator cuff tear
 Postoperatively, the arm is immobilized in an adjusted abduction brace for 6 to 12 weeks. Then, the splint is removed and scapulothoracic motion is allowed. Strengthening is not allowed before 12 weeks, and full activity is allowed when radiographic healing is observed.