Milwaukee shoulder (early)

Case contributed by Dr Domenico Nicoletti

Presentation

Pain and functional limitation.

Patient Data

Age: 70 years
Gender: Male
X-ray

Left shoulder radiographs: Uniform reduction of glenohumeral joint space. Small linear calcifications near the upper and lower margins of the humeral head without destruction of the articular surface.

Annotated image

The intra-articular calcifications are indicated by arrows. 

Case Discussion

Milwaukee shoulder, or destructive shoulder arthropathy, usually affects elderly women, associated with the deposition of hydroxyapatite crystals, with joint effusion and rotator cuff tear.

The findings, in this case, are consistent with Milwaukee shoulder caught at quite an early stage, as there is no evident destruction of the articular surfaces of the glenohumeral joint and no narrowing of the subacromial space as a sign of complete supraspinatus tendon tear. Substantial glenohumeral joint narrowing can either be attributed to destructive arthropathy or to osteoarthritis. The main differential diagnosis for the linear calcifications is chondrocalcinosis from calcium pyrophosphate deposition disease (CPPD), where they tend to be more uniform and extensive.

Case courtesy of Prof Fabio Denicolò.

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Case information

rID: 53964
Case created: 15th Jun 2017
Last edited: 20th Jun 2017
Inclusion in quiz mode: Excluded

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