Marcia S. Genta, M.D. Cem Gabay, M.D.
Geneva University Hospital 1211 Geneva 14, Switzerland
An 85-year-old woman presented with right shoulder pain and swelling and a large hematoma extending into the chest wall. Active range of motion was severely limited, and passive mobility was painful but largely unrestricted. She had had no recent trauma to the shoulder area. Arthrocentesis yielded a hemorrhagic noninflammatory fluid; no crystals were seen on polarized microscopy. Alizarin red staining of the synovial fluid showed rare hydroxyapatite crystals. All cultures were negative, and cancer was not detected by cytologic analysis. Radiography of the right shoulder was suggestive of degenerative arthritis and lateral distention of the subacromial bursa (Panel A). Three months later, the patient presented with similar clinical findings, although at this time radiography showed complete destruction of the humeral head (Panel B, arrow). Milwaukee shoulder, a rare arthropathy that mainly affects elderly women, was diagnosed, and the patient was treated conservatively. A year later, the patient presented with similar clinical symptoms and radiographic findings in the left shoulder and continues to have severely limited active and passive range of motion. Milwaukee shoulder is characterized by intraarticular or periarticular hydroxyapatite crystals and rapid destruction of the rotator cuff and the glenohumeral joint.
The New England of Medicine. Volume 354:e2 January 12, 2006 Number 2.