Milwaukee shoulder/knee syndrome
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Etiology
- basic calcium phosphate deposition arthritis
- often occurs in the setting of overuse or trauma
Epidemiology
- 80% are women
- average age is 72 years, range 50-90 years
Pathology
- glenohumeral joint degeneration
- soft tissue calcification
- rotator cuff tears
- electron microscopy (EM) shows crystals of hydroxyapatite
History
Clinical manifestations
- generally dominant shoulder is involved
- pain, stiffness & is swelling tend to occur gradually
- symptoms may be bilateral
- symptoms range from asymptomatic to severe pain at rest & at night
- active range of motion is limited
- passive range of motion may be preserved
- large non-inflammatory effusion[3]
Laboratory
- synovial fluid from joint aspiration
- few WBC (case[2] of 8300 leukocytes/uL)
- few to many RBC
- no crystals seen
- individual crystals cannot be seen on routine polarization microscopy
- small, round bodies 0.5-100 um seen as lumps of crystals
- positive identification requires electron microscopy or elemental analysis
- Alizarin red staining for Ca+2 with crystals visualized as large globular clumps
Radiology
- destruction of subchondral bone
- soft tissue swelling
- intra-articular effusion is usually present
- X-ray may show articular & periarticular dystrophic calcification
Differential diagnosis
- CPPD
- gout
- septic arthritis
- adhesive capsulitis
- both active & passive range of motion limited
* non-inflammatory synovial fluid in Milwaukee shoulder syndrome
Management
- non-steroidal anti-inflammatory drugs (NSAIDS)
- steroid joint injection
- aspiration of shoulder joint if indicated
- tidal irrigation
- surgical: complete arthroplasty
More general terms
Additional terms
References
- ↑ Weiner, S in: Intensive Course in Geriatric Medicine & Board Review, Santa Monica, CA, Sept 20-23, 2000
- ↑ 2.0 2.1 Weiner, S in: Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
- ↑ 3.0 3.1 Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17. American College of Physicians, Philadelphia 2009, 2012, 2015
- ↑ Forster CJ, Oglesby RJ, Szkutnik AJ, Roberts JR. Positive alizarin red clumps in Milwaukee shoulder syndrome. J Rheumatol. 2009 Dec;36(12):2853 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19966203
- ↑ Genta MS and Gabay C. Images in clinical medicine. Milwaukee shoulder. N Engl J Med 2006 Jan 13; 354:e2 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16407503
- ↑ Halverson PB Crystal deposition disease of the shoulder (including calcific tendonitis and milwaukee shoulder syndrome). Curr Rheumatol Rep. 2003 Jun;5(3):244-7 PMID: https://www.ncbi.nlm.nih.gov/pubmed/12744818