Milwaukee shoulder
Updates to Article Attributes
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. The knees are affected in ~50% of cases.
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 film
The plain film 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.
MRI
MRI findings mirror those of the plain films 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 (i.e. supportive treatment for symptom relief) 3.
Differential diagnosis
General imaging differential considerations include
- Charcot joint
- rapidly destructive osteoarthritis of the hip
- vanishing bone disease
- advanced secondary osteoarthritis
- previous trauma
- previous septic arthritis
See also
-<p><strong>Milwaukee shoulder</strong> refers to a destructive <a href="/articles/shoulder-arthropathy-">shoulder arthropathy</a> due to deposition of <a href="/articles/hydroxyapatite-deposition-disease">hydroxyapatite crystals</a>, and identification of these crystals in synovial fluid is the cornerstone of diagnosis. The knees are affected in ~50% of cases.</p><h4>Epidemiology</h4><p>Milwaukee shoulder frequently affects older women, often with a history of trauma to the region. </p><h4>Clinical presentation</h4><p>Symptoms are usually comparatively mild, despite rapid and marked progression of radiographic features. </p><h4>Radiographic features</h4><h5>Plain film</h5><p>The plain film findings are striking and almost resembles a <a href="/articles/neuropathic-joint">neuropathic joint</a>, with advanced articular surface destruction with <a href="/articles/intra-articular-loose-bodies">intra-articular loose bodies</a>, subchondral sclerosis, soft tissue swelling and <a href="/articles/rotator-cuff">rotator cuff</a> disruption. </p><h5>MRI</h5><p>MRI findings mirror those of the plain films and include: </p><ul>- +<p><strong>Milwaukee shoulder</strong> refers to a destructive <a href="/articles/shoulder-arthropathy-">shoulder arthropathy</a> due to deposition of <a href="/articles/hydroxyapatite-deposition-disease">hydroxyapatite crystals</a>, and identification of these crystals in synovial fluid is the cornerstone of diagnosis. The knees are affected in ~50% of cases.</p><h4>Epidemiology</h4><p>Milwaukee shoulder frequently affects older women, often with a history of trauma to the region. </p><h4>Clinical presentation</h4><p>Symptoms are usually comparatively mild, despite rapid and marked progression of radiographic features. </p><h4>Radiographic features</h4><h5>Plain film</h5><p>The plain film findings are striking and almost resembles a <a href="/articles/neuropathic-joint">neuropathic joint</a>, with advanced articular surface destruction with <a href="/articles/intra-articular-loose-bodies-2">intra-articular loose bodies</a>, subchondral sclerosis, soft tissue swelling and <a href="/articles/rotator-cuff">rotator cuff</a> disruption. </p><h5>MRI</h5><p>MRI findings mirror those of the plain films and include: </p><ul>
-<li><a title="rapidly destructive osteoarthritis of the hip" href="/articles/rapidly-destructive-osteoarthritis-of-the-hip">rapidly destructive osteoarthritis of the hip</a></li>-<li><a title="Vanishing bone disease" href="/articles/gorham-disease">vanishing bone disease</a></li>- +<li><a href="/articles/rapidly-destructive-osteoarthritis-of-the-hip">rapidly destructive osteoarthritis of the hip</a></li>
- +<li><a href="/articles/gorham-disease">vanishing bone disease</a></li>
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