Doctors took a look at man’s painful shoulder—they found the joint was missing

医生检查一名男子的疼痛肩膀时，发现他的关节竟然“消失”了

A 45-year-old construction worker went to the emergency department for his right shoulder, which was extremely swollen and becoming progressively more painful. Doctors took an X-ray to try to see what was causing the problem. But when the images came through, it was what they didn’t see that explained the situation: His entire shoulder joint was gone, seemingly blasted apart into small, lingering pieces.

一名45岁的建筑工人因右肩极度肿胀且疼痛日益加剧而前往急诊科就诊。医生通过X光检查试图找出病因。然而，当影像结果出来时，正是那些“缺失”的部分揭示了真相：他整个肩关节已经消失，仿佛被炸成了细小的碎片。

The shoulder joint is a ball-and-socket joint, with the sphere-like head of the upper arm bone (humerus) sitting in the socket of the shoulder blade. According to a case report in the New England Journal of Medicine, the man’s X-ray showed that he no longer had a ball at all or an intact socket. His upper arm bone was detached from the joint, and the sphere-like top of his upper arm bone (humeral head) was completely gone. The broken, headless humerus was instead left to float freely in the man’s arm, unattached to his upper body.

肩关节属于球窝关节，上臂骨（肱骨）球状的头部嵌入肩胛骨的关节窝中。根据《新英格兰医学杂志》的一份病例报告，该男子的X光片显示，他的关节球已完全消失，关节窝也不再完整。他的上臂骨与关节脱离，肱骨头（上臂骨顶端的球状部分）已完全不见。断裂且失去头部的肱骨只能在手臂中自由浮动，与上半身失去了连接。

Magnetic resonance imaging, meanwhile, found that the man’s rotator cuff—the group of muscles and tendons that holds the upper arm firmly in the socket—was also destroyed. Three of the four main tendons (supraspinatus, infraspinatus, and subscapularis tendons) had full-thickness tears.

与此同时，磁共振成像（MRI）检查发现，该男子的肩袖——即那组将上臂牢牢固定在关节窝中的肌肉和肌腱群——也遭到了破坏。四条主要肌腱中的三条（冈上肌腱、冈下肌腱和肩胛下肌腱）出现了全层撕裂。

The doctors diagnosed the man with a rare, ruinous condition called “Milwaukee Shoulder Syndrome” or MSS. The term was coined in 1981 based on the cases of four elderly women in Wisconsin who, like the man, had severe destruction of their shoulder joints and massive tears to their rotator cuffs. The condition is similar to—and possibly a subtype of—rapid destructive arthritis, which was identified a year later in 1982.

医生诊断该男子患有一种罕见且具有破坏性的疾病，称为“密尔沃基肩综合征”（Milwaukee Shoulder Syndrome，简称MSS）。该术语于1981年首次提出，源于威斯康星州四名老年女性的病例，她们和这名男子一样，肩关节遭受了严重破坏，肩袖也出现了大面积撕裂。这种疾病与1982年发现的“快速破坏性关节炎”相似，甚至可能是其一个亚型。

Despite being identified decades ago, the exact trigger of the joint-demolishing condition is still unclear. But doctors have hypothesized a series of events that leads to the disintegration. The hallmark of MSS is the deposition of calcium-containing crystals, specifically hydroxyapatite crystals, in the joint. These crystals may spur the production of enzymes that can attack and destroy tissues around the joint, including the rotator cuff. The attack is followed by inflammation and swelling that together cause damage that snowballs to complete joint destruction, which can progress rapidly. In the man’s case, he said his shoulder pain had mounted over just two months.

尽管这种关节破坏性疾病已被发现数十年，但其确切诱因尚不明确。不过，医生推测了一系列导致关节崩解的过程。MSS的标志性特征是含钙晶体（特别是羟基磷灰石晶体）在关节内的沉积。这些晶体可能会刺激产生攻击并破坏关节周围组织（包括肩袖）的酶。随之而来的炎症和肿胀会引发连锁反应，导致关节彻底损毁，且病情进展迅速。就该男子的病例而言，他表示自己的肩痛在短短两个月内就加剧到了这种程度。

MSS is most often seen in women and has been linked to prior shoulder trauma and surgeries. It’s unclear why the middle-aged man in this case had the misfortune of developing it, but his doctors noted he had a pre-existing rotator cuff injury, and his work in construction put him at higher risk.

MSS多见于女性，且与既往肩部外伤和手术史有关。目前尚不清楚为何这名中年男子会不幸患上此病，但医生指出他曾有肩袖损伤史，且建筑工作使他处于更高的风险之中。

When caught early, MSS may be treated conservatively with anti-inflammatory medications and sometimes colchicine, a treatment for gout. But for a case as bad as the man’s, the main treatment is a full shoulder replacement. His doctors in the emergency department gave him pain and anti-inflammatory medication and referred him for a surgery evaluation.

如果及早发现，MSS可以通过抗炎药物进行保守治疗，有时也会使用治疗痛风的药物秋水仙碱。但对于像该男子这样严重的病例，主要的治疗方法是进行全肩关节置换术。急诊科医生为他开了止痛药和抗炎药，并建议他进行手术评估。