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Efficacy of Tidal Irrigation in Milwaukee Shoulder Syndrome
OSCAR EPIS, ROBERTO CAPORALI, CARLO A. SCIRÈ, ELEONORA BRUSCHI, ELEONORA BONACCI, and CARLOMAURIZIO MONTECUCCO
ABSTRACT. Methods. Ten patients with clinical diagnosis of MSS underwent ultrasound examination and tidal irrigation followed by instillation of methylprednisolone and tranexamic acid. A single shoulder was treated in 9 cases; in one patient with bilateral shoulder involvement, both shoulders were treated at different times. Six patients had longlasting disease (Group A) unsuccessfully treated with repeated joint fluid aspirations and intraarticular corticosteroid injections. Four patients had recent-onset illness without radiologic damage but with clinical findings similar to classic MSS (Group B), not previously treated with corticosteroid injections with symptoms dating from 3 months or less. Clinical examination including evaluation of adverse events, range of motion, and pain score by a 100 mm horizontal visual analog scale was scheduled just before tidal irrigation and after 2 and 6 months following the procedure in all cases. Results. Short- and longterm safety was excellent in all patients. Group A patients experienced short-lived improvement so that tidal irrigation had to be repeated within 6 to 10 months. No further therapy was necessary in any of the Group B patients during a mean followup of 16.5 months (range 12–24) due to a persistent clinical improvement without clinically detectable joint effusion. Conclusion. Closed-needle joint irrigation is a minimally invasive procedure, which led to a significant improvement in both pain and active motion in patients with longstanding symptoms. Patients with recent-onset disease recovered completely. (First Release June 1 2007; J Rheumatol 2007;34:1545-50) Key Indexing Terms:
MILWAUKEE SHOULDER SYNDROME From the Department of Rheumatology, University of Pavia, and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy. O. Epis, MD; R. Caporali, MD; C.A. Scirè, MD; E. Bruschi, MD; E. Bonacci, MD; C. Montecucco, MD, Department of Rheumatology, University of Pavia, and IRCCS Policlinico S. Matteo Foundation. Address reprint requests to Prof. R. Caporali, UO Reumatologia, 4 Piano Reparti Speciali, IRCCS Policlinico S. Matteo, Piazzale Golgi 2, 27100 Pavia, Italy. E-mail: caporali@smatteo.pv.it Accepted for publication February 19, 2007. |
