Milwaukee shoulder syndrome

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Milwaukee shoulder syndrome
Specialty Rheumotology

Milwaukee shoulder syndrome (MSS) (apatite-associated destructive arthritis/Basic calcium phosphate (BCP) crystal arthritis/rapid destructive arthritis of the shoulder [1] is a rare [2] rheumatological condition similar to pseudogout, associated with periarticular or intra-articular deposition of hydroxyapatite or basic calcium phosphate (BCP) crystals. While primarily associated with the shoulder joint, it can affect any joint in the body below the head. [3] Along with symptomatology, the disease typically presents with positive radiologic findings, often showing marked erosion of the humeral head, cartilage, capsule, and bursae. Though rare, it is most often seen in females beginning in their 50s or 60s. Patients often have a history of joint trauma or overuse, calcium pyrophosphate dehydrate crystal deposition, neuroarthropathy, dialysis-related arthropathy or denervation. [2]

Contents

Nomenclature

According to Nadarajah and Weikert, "[t]he term Milwaukee shoulder syndrome was first used in 1981 to describe four elderly women in Milwaukee... with recurrent bilateral shoulder effusions, radiographic evidence of severe destructive changes of the glenohumeral joints, and massive tears of the rotator cuff." [2]

Signs and symptoms

Signs and symptoms may include the following:

Diagnosis

Diagnosis is made with arthrocentesis and Alizarin Red staining along with clinical symptoms. [5] X-rays, arthrography, ultrasonography, CT imaging and MRI imaging are also helpful in diagnosing this condition[ citation needed ]

Causes

Hydroyapatite crystal deposition in the joint causes the release of collagenases, serine proteases, elastases, and interleukin-1. This leads to acute and rapid decline in joint function and degradation of joint anatomy. Subsequently, disruption of the rotator cuff ensues. [6] [3]

Treatment

Treatment may include the prescription of one or more of the following:

Related Research Articles

Joint Location at which two or more bones make contact

A joint or articulation is the connection made between bones in the body which link the skeletal system into a functional whole. They are constructed to allow for different degrees and types of movement. Some joints, such as the knee, elbow, and shoulder, are self-lubricating, almost frictionless, and are able to withstand compression and maintain heavy loads while still executing smooth and precise movements. Other joints such as sutures between the bones of the skull permit very little movement in order to protect the brain and the sense organs. The connection between a tooth and the jawbone is also called a joint, and is described as a fibrous joint known as a gomphosis. Joints are classified both structurally and functionally.

Shoulder Part of the body

The human shoulder is made up of three bones: the clavicle (collarbone), the scapula, and the humerus as well as associated muscles, ligaments and tendons. The articulations between the bones of the shoulder make up the shoulder joints. The shoulder joint, also known as the glenohumeral joint, is the major joint of the shoulder, but can more broadly include the acromioclavicular joint. In human anatomy, the shoulder joint comprises the part of the body where the humerus attaches to the scapula, and the head sits in the glenoid cavity. The shoulder is the group of structures in the region of the joint.

Synovial fluid Fluid found in the cavities of synovial joints

Synovial fluid, also called synovia,[help 1] is a viscous, non-Newtonian fluid found in the cavities of synovial joints. With its egg white–like consistency, the principal role of synovial fluid is to reduce friction between the articular cartilage of synovial joints during movement. Synovial fluid is a small component of the transcellular fluid component of extracellular fluid.

Rotator cuff tear Medical condition

A rotator cuff tear is an injury where one or more of the tendons or muscles of the rotator cuff of the shoulder get torn. Symptoms may include shoulder pain, which is often worse with movement, or weakness. This may limit people’s ability to brush their hair or put on clothing. Clicking may also occur with movement of the arm.

Synovial osteochondromatosis Medical condition

Synovial osteochondromatosis (SOC) is a rare disease that creates a benign change or proliferation in the synovium or joint-lining tissue, which changes to form bone-forming cartilage. In most occurrences, there is only one joint affected, either the knee, the hip, or the elbow. Rarely involves the TMJ.

Calcium pyrophosphate dihydrate crystal deposition disease Medical condition

Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease, also known as pseudogout and pyrophosphate arthropathy, is a rheumatologic disease which is thought to be secondary to abnormal accumulation of calcium pyrophosphate dihydrate crystals within joint soft tissues. The knee joint is most commonly affected.

Arthropathy Medical condition

An arthropathy is a disease of a joint.

Snapping hip syndrome Medical condition

Snapping hip syndrome, also referred to as dancer's hip, is a medical condition characterized by a snapping sensation felt when the hip is flexed and extended. This may be accompanied by a snapping or popping noise and pain or discomfort. Pain often decreases with rest and diminished activity. Snapping hip syndrome is commonly classified by the location of the snapping as either extra-articular or intra-articular.

Subacromial bursitis Medical condition

Subacromial bursitis is a condition caused by inflammation of the bursa that separates the superior surface of the supraspinatus tendon from the overlying coraco-acromial ligament, acromion, and coracoid and from the deep surface of the deltoid muscle. The subacromial bursa helps the motion of the supraspinatus tendon of the rotator cuff in activities such as overhead work.

Calcific tendinitis Disorder characterized by calcium deposits in a tendon

Calcific tendinitis is a common condition where calcium deposits form in a tendon, sometimes causing pain at the affected site. Deposits can occur in several places in the body, but are by far most common in the rotator cuff of the shoulder. Around 80% of those with deposits experience symptoms, typically chronic pain during certain shoulder movements, or sharp acute pain that worsens at night. Calcific tendinitis is typically diagnosed by physical exam and X-ray imaging. The disease often resolves completely on its own, but is typically treated with non-steroidal anti-inflammatory drugs to relieve pain, rest and physical therapy to promote healing, and in some cases various procedures to breakdown and/or remove the calcium deposits.

Synovectomy is a procedure where the synovial tissue surrounding a joint is removed. This procedure is typically recommended to provide relief from a condition in which the synovial membrane or the joint lining becomes inflamed and irritated and is not controlled by medication alone. If arthritis is not controlled, it can lead to irreversible joint damage. The synovial membrane or "synovium" encloses each joint and also secretes a lubricating fluid that allows different joint motions such as rolling, folding and stretching. When the synovium becomes inflamed or irritated, it increases fluid production, resulting in warmth, tenderness, and swelling in and around the joint.

Arthrocentesis, or joint aspiration, is the clinical procedure performed to diagnose and, in some cases, treat musculoskeletal conditions. The procedure entails using a syringe to collect synovial fluid from or inject medication into the joint capsule. Laboratory analysis of synovial fluid can further help characterize the diseased joint and distinguish between gout, arthritis, and synovial infections such as septic arthritis.

Shoulder replacement

Shoulder replacement is a surgical procedure in which all or part of the glenohumeral joint is replaced by a prosthetic implant. Such joint replacement surgery generally is conducted to relieve arthritis pain or fix severe physical joint damage.

Shoulder impingement syndrome Medical condition

Shoulder impingement syndrome is a syndrome involving tendonitis of the rotator cuff muscles as they pass through the subacromial space, the passage beneath the acromion. It is particularly associated with tendonitis of the supraspinatus muscle. This can result in pain, weakness, and loss of movement at the shoulder.

Crystal arthropathy is a class of joint disorder that is characterized by accumulation of tiny crystals in one or more joints. Polarizing microscopy and application of other crystallographic techniques have improved identification of different microcrystals including monosodium urate, calcium pyrophosphate dihydrate, calcium hydroxyapatite, and calcium oxalate.

Camptodactyly-arthropathy-coxa vara-pericarditis syndrome is a rare autosomal recessive genetic condition due to a mutation in the gene proteoglycan 4 (PRG4) – a mucin-type glycoprotein that acts as a lubricant for the cartilage surfaces. This gene is also known as lubricin.

Hip pain

Pain in the hip is the experience of pain in the muscles or joints in the hip/ pelvic region, a condition commonly arising from any of a number of factors. Sometimes it is closely associated with lower back pain.

Intermittent hydrarthrosis Medical condition

Intermittent hydrarthrosis (IH), also known as periodic synoviosis, periodic benign synovitis, or periodic hydrarthritis, is a chronic condition of unknown cause characterized by recurring, temporary episodes of fluid accumulation (effusion) in the knee. While the knee is mainly involved, occasionally other joints such as the elbow or ankle can additionally be affected. Fluid accumulation in the joint can be extensive causing discomfort and impairing movement, although affected joints are not usually very painful. While the condition is chronic, it does not appear to progress to more destructive damage of the joint. It seems to affect slightly more women than men.

Chondrocalcinosis Medical condition

Chondrocalcinosis or cartilage calcification is calcification in hyaline cartilage and/or fibrocartilage. It can be seen on radiography.

References

  1. Lequesne, M; Fallut, M; Coulomb, R; Magnet, J L; Strauss, J (1982). "L'arthropathie destructrice rapide de l'épaule" [Rapid destructive arthropathy of the shoulder]. Revue du rhumatisme et des maladies ostéo-articulaires (in French). 49: 427–437. PMID   7112022 . Retrieved 8 December 2021.
  2. 1 2 3 Nadarajah, Channa Vasanth; Weichert, Immo. "Milwaukee Shoulder Syndrome (case report)". Case Reports in Rheumatology. Hindawi Limited. doi:10.1155/2014/458708 . Retrieved 8 December 2021. CC-BY icon.svg Text was copied from this source, which is available under a Creative Commons Attribution 3.0 (CC BY 3.0) license.
  3. 1 2 Genta, Marcia S., Gambay, Cem. Milwaukee Shoulder. New England Journal of Medicine. 354;2. January 12, 2006
  4. "Milwaukee Shoulder Syndrome". Archived from the original on 21 January 2016. Retrieved 9 Jan 2016.
  5. Epis O, Viola E, Bruschi E, Benazzo F, Montecucco C. Reumatismo. 2005 Apr-Jun;57(2):69-77
  6. https://archive.today/20120223034722/http://www.medcyclopaedia.com/library/topics/volume_iii_1/m/milwaukee_shoulder_syndrome/gmilwaukee_shoulder_syn_fig01.aspx Milwaukee Shoulder Syndrome], Medcyclopedia (with image), via archive.org. Accessed 2013-1-27.