Shoulder:Glenohumeral Arthritis/Milwaukee shoulder
Contents
Bullet Points[edit | edit source]
Key words[edit | edit source]
Glenohumeral joint; Shoulder; Arthritis; Milwaukee shoulder; Destructive arthropathy; Hydroxyapatite crystals.
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.[1] 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'.[2]
Anecdotes[edit | edit source]
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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.
Clinical Presentation
Symptoms are usually comparatively mild, despite rapid and marked progression of radiographic features.
Imaging
Plain radiograph
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.
MRI
MRI findings mirror those of the plain radiographs and include:
- large shoulder joint effusion
- complete rotator cuff tear
- narrowing of the glenohumeral joint
- thinning of cartilage
- 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.
Discussion
In selected patients, glenohumeral arthrodesis can significantly reduce pain and achieve at best a reasonable function and subjective satisfaction rate. Revision rates favor plate over isolated screw fixation.[3]
References
- ↑ Adams, Robert. A treatise on rheumatic gout, or chronic rheumatic arthritis of all the joints. John Churchill. London, 1957
- ↑ 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
- ↑ Puskas GJ, Lädermann A, Hirsiger S,Hoffmeyer P, Gerber C. Orthop Traumatol Surg Res. 2017;103(6):875-84
