Milwaukee shoulder — SCE Rheumatology MCQ

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ModerateCrystal ArthropathiesMilwaukee shoulderSCE Rheumatology

An 82-year-old woman has chronic massive swelling of the shoulder with little pain and marked loss of function. Aspiration yields blood-stained fluid with low leukocyte count. Radiograph shows rotator cuff destruction and glenohumeral degeneration. Polarised microscopy is unrevealing. What is the most likely diagnosis?

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Correct answer: D — Milwaukee shoulder syndrome

Explanation lettering: D = shown as B · B = shown as C · E = shown as D · C = shown as E

Milwaukee shoulder syndrome is best because elderly woman with destructive shoulder arthropathy, rotator cuff tear and blood-stained low-inflammatory fluid suggests hydroxyapatite-associated Milwaukee shoulder. A is less suitable because gout would show urate crystals and more acute inflammation; B is less suitable because RA would usually have inflammatory synovitis and other joint involvement; C is less suitable because septic arthritis usually has high leukocytes and systemic illness; D is less suitable because PMR does not destroy the shoulder joint. Clinical pearl: low-inflammatory destructive arthropathy can still be crystal-mediated.

Reference: Oxford Textbook of Rheumatology