Shoulder lesion in a 69 year old woman

Andrew J. Hayden, Srivinas Kolla, Adele L. Boskey, Steven A. Burekhovich, Chuanyong Lu, Michael Stracher, Aditya V. Maheshwari

Research output: Contribution to journalArticle

Abstract

Milwaukee shoulder syndrome (MSS) is a painful progressive arthropathy in which hydroxyapatite crystal deposition in synovial tissue induces lysosomal release of collagenase and neutral proteases. These enzymes are destructive to periarticular tissue, including the synovium, articular cartilage, rotator cuff muscles, and the intrasynovial cortical bone. MSS predominantly occurs in women (90%) over the age of 70 years of age with a clinical history marked by recurrent joint effusions and pain that classically worsens at night. Our patient is a 69 year old woman who presented with progressive shoulder pain, most prominent at night, with limited range of motion and swelling; intermittent discharge; and intermittent neck pain that radiated to her right upper extremity. Her medical history was notable for invasive carcinoma of the right breast treated with mastectomy and radiation. She was also treated with radiation therapy for right shoulder pain and a lucent right shoulder lesion presumed to be metastatic breast cancer. The remainder of her medical history consists of hypertension, diabetes mellitus, hyperlipidemia, and uneventful bilateral total knee arthroplasties. At presentation, she denied constitutional symptoms. Based on the patient’s history and physical examination, the differential diagnosis included primary and metastatic malignancy, radiation-induced sarcoma and necrosis, infection, Charcot disease, and crystal arthropathies. Physical examination, laboratory findings, and imaging studies led us to the diagnosis of MSS.

Original languageEnglish (US)
Pages (from-to)47-53
Number of pages7
JournalJournal of Long-Term Effects of Medical Implants
Volume28
Issue number1
DOIs
Publication statusPublished - Jan 1 2018
Externally publishedYes

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Keywords

  • Articular cartilage
  • Calcium hydroxyapatite crystal arthropathy
  • Joint
  • Milwaukee shoulder syndrome
  • Mss
  • Rotator cuff

ASJC Scopus subject areas

  • Biomedical Engineering
  • Dentistry(all)

Cite this

Hayden, A. J., Kolla, S., Boskey, A. L., Burekhovich, S. A., Lu, C., Stracher, M., & Maheshwari, A. V. (2018). Shoulder lesion in a 69 year old woman. Journal of Long-Term Effects of Medical Implants, 28(1), 47-53. https://doi.org/10.1615/JLongTermEffMedImplants.2017020612