Shoulder:Glenohumeral Arthritis/Milwaukee shoulder
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. 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'.
Anecdotes[edit | edit source]
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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. Along with symptomatology, the disease typically presents with positive 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.
Symptoms are usually mild and include deformation, swelling (Figure) or hematoma (Video).
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.
Magnetic Resonance Imaging
Magnetic Resonance Imaging 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
- 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
- Milwaukee Shoulder Syndrome, Medcyclopedia (with image), via archive.org. Accessed 2013-1-27.
- Genta MS, Gambay C. Milwaukee Shoulder. New England Journal of Medicine. 2006;354:2
- Epis O, Viola E, Bruschi E, Benazzo F, Montecucco C.Reumatismo. 2005;57(2):69-77