Disclosures: Joshua M. Romero, MD: No financial relationships or conflicts of interest

Case Diagnosis: Elderly male with subacute severe shoulder pain, swelling, and redness

Case Description or Program Description: An 81-year-old male with medical history significant for a Sacrococcygeal Chordoma status post definitive proton beam radiotherapy presented with two months of severe right shoulder pain. No inciting factor or event occurred before onset of pain. No previous injuries or trauma noted. Any activity involving range of motion about the shoulder produced severe pain. He also reported associated erythema and swelling. A chest CT previously obtained for oncologic purposes revealed a limited view of advanced glenohumeral joint degenerative change and peri-articular calcium deposition.

Setting: Tertiary Care Academic Hospital – Sports Medicine Clinic

Assessment/Results: Physical examination significant for severe swelling in the right anterior shoulder with associated erythema; limited range of motion in all planes secondary to pain; diffuse tenderness about right shoulder; and an unremarkable neurologic examination. 4-view right shoulder radiographs demonstrated severe glenohumeral degenerative change, high-riding humeral head, and intra-articular bodies within glenohumeral joint. MRI right shoulder without IV contrast demonstrated a severe destructive glenohumeral arthropathy with an associated large joint effusion with extensive debris, and a large rotator cuff and biceps tendon tear. These findings were consistent with Milwaukee Shoulder Syndrome (MSS). He was referred to Orthopedic Surgery and will undergo a reverse total shoulder replacement.

Discussion (relevance): MSS is a destructive calcium phosphate crystalline arthropathy that most commonly involves the shoulder and has been reported more commonly in elderly patients. This syndrome can present similarly to other disease processes including septic arthritis, an inflammatory arthritis, crystal-associated arthropathy, or osteonecrosis, therefore having awareness of this syndrome is important.

Conclusions: Development of severe pain, swelling, and erythema in the dominant shoulder of an elderly patient should prompt consideration of MSS as a potential etiology of symptoms.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/subacute-severe-shoulder-pain-and-swelling-concerning-for-milwaukee-shoulder-syndrome-mss-a-case-report/