Milwaukee Syndrome

Milwaukee shoulder syndrome (MSS) (apatite-associated destructive arthritis/Basic calcium phosphate (BCP) crystal arthritis/rapid destructive arthritis of the shoulder is a rare rheumatological condition similar to pseudogout, associated with periarticular or intra-articular deposition of hydroxyapatite or basic calcium phosphate (BCP) crystals.

Causes of Milwaukee Syndrome

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.

Symptoms of Milwaukee Syndrome

  • 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

Diagnosis of Milwaukee Syndrome

  • Diagnosis is made with arthrocentesis and Alizarin Red staining along with clinical symptoms.

  • X-rays, arthrography, ultrasonography, CT imaging and MRI imaging are also helpful in diagnosing this condition

Treatment of Milwaukee Syndrome

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

  • Non-steroidal anti-inflammatory drugs (NSAIDs)

  • Intra-articular steroids

  • Physical therapy

  • Partial or complete arthroplasty

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