Milwaukee shoulder

Last revised by Mostafa Elfeky on 3 Feb 2023

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.

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

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

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:

ADVERTISEMENT: Supporters see fewer/no ads

Cases and figures

  • Case 1: bilateral
    Drag here to reorder.
  • Case 2
    Drag here to reorder.
  • Case 3: early
    Drag here to reorder.
  • Case 4
    Drag here to reorder.
  • Case 5
    Drag here to reorder.
  • Updating… Please wait.

     Unable to process the form. Check for errors and try again.

     Thank you for updating your details.