Presentation
Chronic bilateral shoulder pain, and limited range of motion. Negative trauma, non-diabetic.
Patient Data
There is a bilateral humeral head and neck destruction/resorption, intra-articular debris, joint distension, dislocation, and disorganization. There is osteopenia /osteolysis(density change), of the glenoid fossae (especially right-sided) and the distal right clavicle. There is well-identified soft tissue swelling.
Limited shoulder ultrasound confirmed complex and large joint effusions with complete rotator cuff tears bilaterally. Scattered crystals were present.
Case Discussion
Features suggestive of bilateral Milwaukee shoulder. The 6 D'S of a neuropathic or Charcot's joint are well demonstrated in these views, however, the patient is reported as non-diabetic, and presents with chronic pain rather than the absence of any pain as typically occurs in a neuropathic joint. The presence of sonographically identified crystals also alludes to Milwaukee shoulder. Ultrasound-guided aspiration and laboratory confirmation of hydroxyapatite crystals can confirm the diagnosis. Vanishing bone disease (Gorham disease) is a considered differential diagnosis, however, the age of the patient, absence of any other significant history to suggest multifocal skeletal involvement and the sonographic confirmation of large complex joint effusions and suspected hydroxyapatite crystals suggests Milwaukee shoulder in this instance rather than multifocal vanishing bone disease.
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