Doctors probing man’s shoulder pain find the joint is missing
▼ Summary
– A 45-year-old construction worker sought emergency care for a severely swollen, painful right shoulder, and an X-ray revealed his shoulder joint was completely destroyed, with the humeral head gone and the upper arm bone detached.
– MRI showed his rotator cuff was also destroyed, with full-thickness tears in three of the four main tendons (supraspinatus, infraspinatus, and subscapularis).
– Doctors diagnosed him with Milwaukee Shoulder Syndrome (MSS), a rare condition first named in 1981 based on four elderly Wisconsin women with similar joint destruction and rotator cuff tears.
– MSS is similar to, and possibly a subtype of, rapid destructive arthritis, which was identified a year later in 1982.
A 45-year-old construction worker arrived at the emergency department with a right shoulder that was severely swollen and growing increasingly painful. To pinpoint the source of the problem, doctors ordered an X-ray. The images, however, revealed something far more startling than a typical injury: the entire shoulder joint had vanished, seemingly shattered into fragments that had long since dispersed.
The shoulder operates as a ball-and-socket joint, where the rounded top of the upper arm bone, or humerus, fits into a matching cup on the shoulder blade. According to a case report published in the New England Journal of Medicine, the man’s X-ray showed neither a ball nor an intact socket. His humerus had become completely detached, and the spherical humeral head was entirely absent. The fractured, headless bone was left to drift loosely within the arm, with no connection to the rest of the body.
Further imaging via magnetic resonance imaging revealed additional devastation. The rotator cuff, the network of muscles and tendons responsible for anchoring the upper arm in its socket, was also ruined. Three of its four primary tendons, the supraspinatus, infraspinatus, and subscapularis, had sustained full-thickness tears.
The medical team diagnosed the patient with a rare and destructive condition known as Milwaukee Shoulder Syndrome (MSS). The name originated in 1981, following the study of four elderly women in Wisconsin who exhibited the same pattern of severe joint erosion and massive rotator cuff damage. MSS is closely related to, and may actually be a variant of, rapid destructive arthritis, a condition first documented a year later in 1982.
(Source: Ars Technica)
