Age / Sex : 74 / F

Milwaukee shoulder syndrome

Discussion

Findings:

1. Rapid destruction of the humeral head, with joint space widening and intra-articular or peri-articular calcifications

2. Large joint effusion with synovial thickening, abundant loose bodies, and increased signal intensity of both surrounding soft tissues and bone marrow on T2WI

3. Rotator cuff tear
 

Differential Diagnosis:

Charcot joint

Septic arthritis
 

Discussion:

The term Milwaukee shoulder syndrome (MSS) was first used in 1981 to describe four elderly women in Milwaukee in the state of Wisconsin, USA, with recurrent bilateral shoulder effusions, radiographic evidence of severe destructive changes of the glenohumeral joints, and massive tears of the rotator cuff. MSS has been called rapidly progressive osteoarthritis, apatite associated destructive arthritis, rapid destructive arthritis, idiopathic chondrolysis, and senile hemorrhagic shoulder syndrome. This diversity of nomenclature to address the same disease relates to the controversy surrounding its pathogenesis which still remains unclear. Hydroxyapatite crystals on MSS is known to induce the release of collagenases, serine proteases, elastases, and interleukin-1. This precipitates acute and rapid decline in joint function and degradation of joint anatomy.

The best technique for the diagnosis of MSS is plain radiography. Early radiographic changes consist of a high-riding humeral head due to rotator cuff tear, with mild subchondral bone sclerosis, and narrowing of the glenohumeral joint space, with little or no osteophytosis. These changes may stabilize or show minimal cartilage erosions for several years, followed by sudden and dramatic deterioration. There is striking structural joint damage associated with rotator cuff tears and severe instability. Joint effusion is often voluminous, blood-stained (80%), and contains hydroxyapatite and less commonly pyrophosphate crystals. MRI can have a complementary role, more assessing the osseous, chondral, and soft-tissue associated changes. It should be noted that it requires correlative analysis with the radiographic studies, to avoid misleading diagnosis due to the extensive soft tissue changes. CT can be helpful in detailing the bony destruction and pre-operative planning.
 

References:

https://radiopaedia.org/articles/milwaukee-shoulder

http://www.eurorad.org/case.php?id=8100