SHM Converge Scientific Abstract ePoster Gallery-Milwaukee Shoulder Syndrome in 41 Year-Old With End Stage Renal Disease

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Milwaukee shoulder syndrome (MSS), also called calcific tendinitis or hydroxyapatite deposition disease, is a rare destructive shoulder arthropathy caused by calcium hydroxyapatite crystal deposition, most often in the supraspinatus tendon but potentially involving other rotator cuff tendons and adjacent bone. It typically affects elderly women and can lead to chronic shoulder pain, reduced function, and bone erosion. Although the deposits may resorb spontaneously, treatment is usually supportive.<br /><br />This case describes a 41-year-old woman with end-stage renal disease (ESRD) due to focal segmental glomerulosclerosis, on peritoneal dialysis, with additional history of uremic pericardial effusion and gout. She was transferred for concern about recurrent pericarditis but presented with severe right shoulder pain radiating to the neck, pleuritic chest pain, jaw pain, headache, diffuse myalgias, and polyarthralgias. She had no direct shoulder trauma, though she had recently sustained lumbar transverse process fractures after a fall.<br /><br />Imaging revealed hydroxyapatite deposition disease with chronic erosion of the distal clavicle, soft tissue edema, and multifocal calcifications in the supraspinatus and subscapularis tendons. She was treated with intravenous steroids followed by an oral steroid taper, with gradual improvement in pain.<br /><br />The report highlights that calcific tendinitis with bone erosion is very uncommon, especially in patients with ESRD. ESRD likely contributed significantly to this unusually young presentation. In similar cases, management may also require lowering calcium and phosphate levels and adjusting dialysis settings; if standard therapy fails, sodium thiosulfate has been reported as a possible treatment option.

Asset Subtitle

Deepa Kumarjiguda

Meta Tag

Author List Deepa Kumarjiguda, Maria A. Qureshi, Shreya Vatsala, Sonu Santhosh

Category Clinical Vignettes

Concept Milwaukee Shoulder Syndrome

Concept Shoulder Arthropathy

Concept Rotator Cuff Tendon

Concept Erosive Changes

Concept End-stage Kidney Disease

Distinguished Non-Finalist

Presenter Organization Geisinger Medical Center

Presenting Author Deepa Kumarjiguda

Track Adult

Keywords

Milwaukee shoulder syndrome

calcific tendinitis

hydroxyapatite deposition disease

shoulder arthropathy

calcium hydroxyapatite crystals

end-stage renal disease

peritoneal dialysis

rotator cuff calcification

bone erosion

steroid treatment

Milwaukee Shoulder Syndrome

Shoulder Arthropathy

Rotator Cuff Tendon

Erosive Changes

End-stage Kidney Disease