Mccarty, Arthritis Rheum 1981 - “Milwaukee Shoulder”—Association of Microspheroids Containing Hydroxyapatite Crystals, Active Collagenase, and Neutral Protease with Rotator Cuff Defects. I. Clinical Aspects
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“Milwaukee Shoulder”—Association of Microspheroids Containing Hydroxyapatite Crystals, Active Collagenase, and Neutral Protease with Rotator Cuff Defects. I. Clinical Aspects
McCarty, Kozin, et al.·Arthritis Rheum·1981·315 citations·Case series
McCarty and colleagues described the clinical features of 4 patients whose degenerated shoulders had rotator cuff tears and joint fluid containing crystals and active enzymes, and they proposed this combination as a distinct syndrome.
Case series of 4 women aged 63 to 90, with 8 shoulders and 13 synovial fluid samples studied.
Methods
Design
Case series
Patients
4 women aged 63 to 90
8 shoulders
Mildly painful shoulders with reduced mobility or stability
Outcomes
Radiographic rotator cuff integrity
Synovial fluid microspheroids on scanning electron microscopy
Collagenase and neutral protease activity
Synovial fluid leukocyte counts
14C‑EHDP binding in joint fluid
Key Findings
The rotator cuff was completely torn in 7 of the 8 shoulders.
Scanning electron microscopy showed microspheroids carrying hydroxyapatite in 12 of the 13 joint fluid samples.
Active collagenase and neutral protease were found in the joint fluids of 3 of the 4 patients.
No polymorphonuclear leukocytes were found in any fluid, so the authors suggest the enzymes probably came from the synovial cells.
Symptoms were surprisingly mild despite marked radiographic destruction, and every patient kept some use of each arm.
After synovectomy in one patient, the effusion recurred with much less collagenase activity and no hydroxyapatite crystals.
Board pearl
Milwaukee shoulder pairs a complete rotator cuff tear with a noninflammatory effusion that holds hydroxyapatite microspheroids and active collagenase and neutral protease but no polymorphonuclear leukocytes.
Authors' conclusion
This constellation of findings represents a heretofore undescribed syndrome which we have designated "Milwaukee shoulder."
“Milwaukee Shoulder”—Association of Microspheroids Containing Hydroxyapatite Crystals, Active Collagenase, and Neutral Protease with Rotator Cuff Defects. I. Clinical Aspects
McCarty, Kozin, et al.·Arthritis Rheum·1981·315 citations·Case series
McCarty and colleagues described the clinical features of 4 patients whose degenerated shoulders had rotator cuff tears and joint fluid containing crystals and active enzymes, and they proposed this combination as a distinct syndrome.
Case series of 4 women aged 63 to 90, with 8 shoulders and 13 synovial fluid samples studied.
Methods
Design
Case series
Patients
4 women aged 63 to 90
8 shoulders
Mildly painful shoulders with reduced mobility or stability
Outcomes
Radiographic rotator cuff integrity
Synovial fluid microspheroids on scanning electron microscopy
Collagenase and neutral protease activity
Synovial fluid leukocyte counts
14C‑EHDP binding in joint fluid
Key Findings
The rotator cuff was completely torn in 7 of the 8 shoulders.
Scanning electron microscopy showed microspheroids carrying hydroxyapatite in 12 of the 13 joint fluid samples.
Active collagenase and neutral protease were found in the joint fluids of 3 of the 4 patients.
No polymorphonuclear leukocytes were found in any fluid, so the authors suggest the enzymes probably came from the synovial cells.
Symptoms were surprisingly mild despite marked radiographic destruction, and every patient kept some use of each arm.
After synovectomy in one patient, the effusion recurred with much less collagenase activity and no hydroxyapatite crystals.
Board pearl
Milwaukee shoulder pairs a complete rotator cuff tear with a noninflammatory effusion that holds hydroxyapatite microspheroids and active collagenase and neutral protease but no polymorphonuclear leukocytes.
Authors' conclusion
This constellation of findings represents a heretofore undescribed syndrome which we have designated "Milwaukee shoulder."