Milwaukee shoulder

Last revised by Liz Silverstone on 10 Jun 2024

Milwaukee shoulder refers to a destructive arthropathy associated with advanced rotator cuff tears and deposition of basic calcium phosphate crystals including hydroxyapatite crystals.

Milwaukee shoulder frequently affects older women with an age range of 50 - 90 years, often with a history of trauma to the region. 

Symptoms are usually comparatively mild, despite rapid and marked progression of radiographic features. Other joints can be affected by a similar process.

Alizarin red S stain identifies clumped calcium hydroxyapatite crystals which produce a “halo” of orange-red stain.

Radiographic findings are striking and resemble 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 findings mirror those of the plain radiographs and include: 

No specific treatment is available, only supportive treatment for symptom relief 3

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 5. 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" 6

General imaging differential considerations include:

Cases and figures

  • Case 1: bilateral
  • Case 2
  • Case 3: early
  • Case 4
  • Case 5
:

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