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Journal of Long-Term Effects of Medical Implants
SJR: 0.145 SNIP: 0.491 CiteScore™: 0.89

ISSN Druckformat: 1050-6934
ISSN Online: 1940-4379

Journal of Long-Term Effects of Medical Implants

DOI: 10.1615/JLongTermEffMedImplants.2017020612
pages 47-53

Shoulder Lesion in a 69 Year Old Woman

Andrew J. Hayden
Department of Orthopaedic Surgery and Rehabilitation, SUNY Downstate Medical Center, Brooklyn, New York 11203
Srinivas Kolla
Department of Radiology, SUNY Downstate Medical Center, Brooklyn, NY 11203, USA
Adele L. Boskey
Hospital for Special Surgery, New York, New York 10021
Steven A. Burekhovich
Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY), Downstate Medical Center, Brooklyn, NY
Chuanyong Lu
Department of Pathology, SUNY Downstate Medical Center, Brooklyn, New York 11203
Michael Stracher
Department of Orthopedic Surgery, Maimonides Medical Center, Brooklyn, New York 11219
Aditya V. Maheshwari
Department of Pathology, SUNY Downstate Medical Center, Brooklyn, NY 11203, USA

ABSTRAKT

Milwaukee Shoulder Syndrome (MSS) is a painful progressive arthropathy in which hydroxyapatite crystal deposition in synovial tissue induces lysosomal release of collagenase and neutral proteases. These enzymes are destructive to periarticular tissue, including the synovium, articular cartilage, rotator cuff muscles, and the intrasynovial cortical bone. MSS predominantly occurring in women (90%) over the age of 70 years of age with a clinical history marked by recurrent joint effusions and pain, which classically worsens at night. Our patient is a 69-year-old woman who presented with progressive shoulder pain, most prominent at night, with limited range of motion and swelling; intermittent discharge; and intermittent neck pain that radiated to her right upper extremity. Her medical history was notable for invasive carcinoma of the right breast treated with mastectomy and radiation. She was also treated with radiation therapy for right shoulder pain and a lucent right shoulder lesion presumed to be metastatic breast cancer. The remainder of her medical history consists of hypertension, diabetes mellitus, hyperlipidemia, and uneventful bilateral total knee arthroplasties. At presentation, she denied constitutional symptoms. Based on the patient's history and physical exam the differential diagnosis included primary and metastatic malignancy, radiation induced sarcoma and necrosis, infection, Charcot disease, and crystal arthropathies. Physical exam, laboratory findings, and imaging studies led us to the diagnosis of MSS.


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