Milwaukee shoulder syndrome

Milwaukee Shoulder Syndrome (apatite-associated destructive arthritis) is a rheumatological condition similar to Calcium pyrophosphate dihydrate deposition disease (CPPD), and is the result of periarticular or intraarticular deposition of hydroxyapatite crystals. Crystal deposition in the joint causes the release of collagenases, serine proteases, elastases, and interleukin-1. This precipitates acute and rapid decline in joint function and degradation of joint anatomy. Along with symptomatology, the disease typically presents with positive radiologic findings, often showing marked erosion of the humoral head, cartilage, capsule, and bursae. Though rare, it is most often seen in elderly females beginning in the fifth or sixth decade of life. Diagnosis is made with arthrocentesis and Alizarin Red staining along with clinical symptoms.

Risk Factors

The following factors have been found^{[by whom?]} to predispose an individual to Milwaukee Shoulder Syndrome:

• Mechanical Overuse or Trauma
• CPPD deposition
• Denervation
• Dialysis
• Female Sex
• Advanced Age

Symptoms

Symptoms may include:

• Limited active range of motion, usually unrestricted passive range of movement (early)
• Joint Pain
• Joint inflammation and tenderness
• Synovial hemorrhagic effusion/hematoma
• Radiologic Positive Findings
• Hydroxyapatite crystals in synovial fluid

Treatment

Treatment may include the prescription of:

• Non-steroidal anti-inflammatory drugs(NSAID)
• Intraarticular steroids
• Physical therapy
• Partial or complete arthroplasty

Sources

• Genta, Marcia S., Gambay, Cem. Milwaukee Shoulder. New England Journal of Medicine. 354;2. January 12, 2006
• Epis O, Viola E, Bruschi E, Benazzo F, Montecucco C.Reumatismo. 2005 Apr-Jun;57(2):69-77.
• Nguyen, VD. Rapid destructive arthritis of the shoulder. Skeletal Radiology. 1996 Feb;25(2):107-12.
• http://www.medcyclopaedia.com/library/topics/volume_iii_1/m/milwaukee_shoulder_syndrome/gmilwaukee_shoulder_syn_fig01.aspx