Milwaukee shoulder syndrome — SCE Rheumatology MCQ

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EasyCrystal ArthropathiesMilwaukee shoulder syndromeSCE Rheumatology

A 82-year-old man has a rapidly destructive shoulder arthropathy, large non-inflammatory effusion, rotator cuff tear and intra-articular calcific debris. What is the most likely diagnosis?

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Correct answer: B — Milwaukee shoulder syndrome

Milwaukee shoulder syndrome is the single best answer because destructive shoulder arthropathy with basic calcium phosphate deposition suggests Milwaukee shoulder. The stem is testing diagnostic synthesis, not isolated recall, so the relevant clinical pattern and risk context determine the answer. Septic arthritis is less suitable because it fits a different clinical pattern or a different treatment threshold; Reactive arthritis, Serum urate alone and Allopurinol during severe drug rash do not address the key discriminator in this vignette. Clinical pearl: in SCE-style rheumatology questions, autoantibodies, imaging and synovial fluid findings should be interpreted with the whole phenotype.

Reference: NICE NG219; BSR gout and hot swollen joint guidance; BNF