1998 Volume 22 Issue 2 Pages 193-197
A rare of cuff tear arthropathy associated with chondrocalcinosis is presented here. A 76-year-oldwoman with a 10-years-history of bilateral omalgia showed severe rotator cuff insufficiency on physical examination. Laboratory data did not indicate any inflammation. A plan radiograph of the left shoulder showed elevation and collapse of the humeral head. Other radiographs showed chondrocalcinoosis of the knee, the elbow and the write joint. Based on these findings, the authors diagnosed this case as cuff tear arthropathy, and hemiarthroplasty of the humerus was performed. Microscopic examination of the tendon atump of the subscapularis muscle revealed some calcium deposits closely approximating those of CPPD crystal on X-ray diffraction analysis. Cuff tear arthropathy was definds as a combination of a massive cuff tear, elevation and collapse of the humeral head, and damage to the glenohumeral joint. The hypothesis proposed by Neer concerning the pathomechanicism was that a massive cuff tear induces both nutritional and mechanical factors that provide a logical explanation for the development of a humeral head collapse. McCarty described a shoulder condition called the Milwaukee shopulder syndrome, which was nearly identical to cuff tear arthropathy, and emphasized that hydroxyapatite was strongly related to the pathogenesis of this shoulder condition. The authors suggest that the CPPD crystal also hastened the development of cuff tear arthropathy.
