Milwaukee shoulder syndrome

Milwaukee

shoulder. Shoulder X-ray shows deformity and partial destruction of the humeral head, erosion of the glenoid, marked joint space narrowing and cephalic humeral migration with patchy periarticular osteoporosis. Soft-tissue swelling and irregular calcifications are present.

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Milwaukee

shoulder. Axial-CT (A&B) and coronal reformatted (C&D) images confirmed an extensive resorption and deformity of the humeral head; glenoid and acromion. Glenohumeral joint space narrowing, multiple periarticular calcifications and intra-articular loose bodies are present.

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Milwaukee

shoulder. Coronal-fat-sat-T2 (A); axial-T2-FFE (B) reveals: full-thickness tears of the supraspinatus, superior displacement of the humerus, soft-tissue swelling, large effusion and intra-articular loose body. Post-gadolinium-T1 (C;D;E) show contrast enhancement of the thickened synovium.

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Hydroxyapatite

deposition disease • Milwaukee shoudler - bilateral - Ganzer Fall bei Radiopaedia

Dixon, A. Milwaukee shoudler - bilateral. Case study, Radiopaedia.org. (accessed on 06 Nov 2022) https://radiopaedia.org/cases/62681 • CC by-nc-sa 3.0 (modified)

Milwaukee

shoulder • Milwaukee shoulder (probable) - Ganzer Fall bei Radiopaedia

Dixon A, Milwaukee shoulder (probable). Case study, Radiopaedia.org (Accessed on 01 Feb 2023) https://doi.org/10.53347/rID-62680 • CC by-nc-sa 3.0 (modified)

Milwaukee

shoulder • Milwaukee shoulder (early) - Ganzer Fall bei Radiopaedia

Nicoletti D, Milwaukee shoulder (early). Case study, Radiopaedia.org (Accessed on 01 Feb 2023) https://doi.org/10.53347/rID-53964 • CC by-nc-sa 3.0 (modified)

Milwaukee

shoulder • Milwaukee shoulder - Ganzer Fall bei Radiopaedia

Rajadurai S, Milwaukee shoulder. Case study, Radiopaedia.org (Accessed on 01 Feb 2023) https://doi.org/10.53347/rID-84690 • CC by-nc-sa 3.0 (modified)

Milwaukee

shoulder • Milwaukee shoulder - Ganzer Fall bei Radiopaedia

Ranchod A, Milwaukee shoulder. Case study, Radiopaedia.org (Accessed on 14 Aug 2023) https://doi.org/10.53347/rID-160149 • CC by-nc-sa 3.0 (modified)

Radiopaedia • CC-by-nc-sa 3.0 • de

Milwaukee shoulder refers to a destructive shoulder arthropathy due to deposition of hydroxyapatite crystals, and identification of these crystals in synovial fluid is the cornerstone of diagnosis.

Epidemiology

Milwaukee shoulder frequently affects older women, often with a history of trauma to the region.

Clinical presentation

Symptoms are usually comparatively mild, despite rapid and marked progression of radiographic features.

Radiographic features

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 . The superior subluxation can also result in a pseudoarthrosis with the distal clavicle and/or acromion .

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

Treatment and prognosis

No specific treatment is available, only supportive treatment for symptom relief .

History and etymology

Regius Professor of Surgery, Dr Robert Adams (1791 -1875) was an Irish surgeon who 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' .