Milwaukee Shoulder Syndrome (apatite-associated destructive arthritis) is a rheumatological

Rheumatology

Rheumatology is a sub-specialty in internal medicine and pediatrics, devoted to diagnosis and therapy of rheumatic diseases. Clinicians who specialize in rheumatology are called rheumatologists...

 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

Collagenases

Collagenases are enzymes that break the peptide bonds in collagen.They assist in destroying extracellular structures in pathogenesis of bacteria such as Clostridium. They are an exotoxin and help to facilitate the spread of gas gangrene...

, serine proteases, elastase

Elastase

In molecular biology, elastase is an enzyme from the class of proteases that break down proteins.- Forms and classification:There exist eight human genes for elastase:Bacterial forms: Organisms such as P...

s, 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

Radiology

Radiology is a medical specialty that employs the use of imaging to both diagnose and treat disease visualized within the human body. Radiologists use an array of imaging technologies to diagnose or treat diseases...

 findings, often showing marked erosion of the humoral head, cartilage

Cartilage

Cartilage is a flexible connective tissue found in many areas in the bodies of humans and other animals, including the joints between bones, the rib cage, the ear, the nose, the elbow, the knee, the ankle, the bronchial tubes and the intervertebral discs...

, capsule, and bursae

Bursitis

Bursitis is the inflammation of one or more bursae of synovial fluid in the body. The bursae rest at the points where internal functionaries, such as muscles and tendons, slide across bone. Healthy bursae create a smooth, almost frictionless functional gliding surface making normal movement painless...

. Though rare, it is most often seen in elderly females beginning in the fifth or sixth decade of life. Diagnosis is made with arthrocentesis

Arthrocentesis

Arthrocentesis is the clinical procedure of using a syringe to collect synovial fluid from a joint capsule. It is also known as joint aspiration. Arthrocentesis is used in the diagnosis of gout, arthritis, and synovial infections....

 and Alizarin Red staining

Alizarin

Alizarin or 1,2-dihydroxyanthraquinone is an organic compound with formula that has been used throughout history as a prominent dye, originally derived from the roots of plants of the madder genus.Alizarin was used as a red dye for the English parliamentary "new model" army...

 along with clinical symptoms.

Risk Factors

The following factors have been found to predispose an individual to Milwaukee Shoulder Syndrome:

• Mechanical Overuse or Trauma
• CPPD deposition
• Denervation
• Dialysis
  Dialysis
  In medicine, dialysis is a process for removing waste and excess water from the blood, and is primarily used to provide an artificial replacement for lost kidney function in people with renal failure...
  
  
• 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
  Hematoma
  A hematoma, or haematoma, is a localized collection of blood outside the blood vessels, usually in liquid form within the tissue. This distinguishes it from an ecchymosis, which is the spread of blood under the skin in a thin layer, commonly called a bruise...
  
  
• Radiologic Positive Findings
• Hydroxyapatite crystals in synovial fluid

Treatment

Treatment may include the prescription of:

• Non-steroidal anti-inflammatory drug
  Non-steroidal anti-inflammatory drug
  Nonsteroidal anti-inflammatory drugs, usually abbreviated to NSAIDs or NAIDs, but also referred to as nonsteroidal anti-inflammatory agents/analgesics or nonsteroidal Anti-inflammatory medicines , are drugs with analgesic and antipyretic effects and which have, in higher doses, anti-inflammatory...
  
  s(NSAID)
• Intraarticular steroids
• Physical therapy
• Partial or complete arthroplasty
  Arthroplasty
  Arthroplasty is an operative procedure of orthopedic surgery performed, in which the arthritic or dysfunctional joint surface is replaced with something better or by remodeling or realigning the joint by osteotomy or some other procedure.-Background:Previously, a popular form of arthroplasty was...
  
  

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