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Archives of orthopaedic and traumatic surgery

, Volume 107, Issue 4, pp 210–216 | Cite as

Persistent hemarthrosis of the shoulder joint with a rotator-cuff tear in the elderly

  • K. Ishikawa
  • T. Ohira
  • K. Morisawa
Original Articles

Summary

Three elderly patients developed persistent hemarthrosis of the shoulder joint without having suffered injury. Complete tears of the rotator cuff, attrition of the undersurface of the acromion, and instability were noted in the affected shoulders. Synovial fluids examined from two patients contained many alizarin red S-positive microspheroids. The synovium obtained at surgery from two patients showed hypervascularity, vasodilatation, and severe degenerative changes of collagenous tissues. The tendon of the m. supraspinatus showed infiltrations of multinucleated giant cells around calcified deposits consisting of hydroxyapatite crystals. Anatomical and mechanical derangements, and possible biological reactions following phagocytosis of hydroxyapatite crystals, may have contributed to the persistent hemorrhage in the shoulder joints.

Keywords

Public Health Elderly Patient Hydroxyapatite Synovial Fluid Giant Cell 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Banna A, Kendall H (1964) Spontaneous haemarthrosis of the shoulder joint. Ann Phys Med 7:180–184Google Scholar
  2. 2.
    Cheung HS, Halverson PB, McCarty DJ (1981) Release of collagenase, neutral protease, and prostaglandins from cultured mammalian synovial cells by hydroxyapatite and calcium pyrophosphate dihydrate crystals. Arthritis Rheum 24:1338–1344Google Scholar
  3. 3.
    Cohen GL, Myers AR, Harris ED Jr (1969) Idiopathic joint apoplexy. Arthritis Rheum 12:287Google Scholar
  4. 4.
    Grancis JC, Cheung HS, Halverson PB, McCarty DJ (1981) “Milwaukee shoulder”-association of microspheroids containing hydroxyapatite crystals, active collagenase, and neutral protease with rotator cuff defects. III. Morphological and biochemical studies of an excised synovium showing chondromatosis. Arthritis Rheum 24:484–491Google Scholar
  5. 5.
    Halverson PB, Cheung HS, McCarty DJ, Grancis J, Mandel N (1981) “Milwaukee shoulder”-association of microspheroids containing hydroxyapatite crystals, active collagenase and neutral protease with rotator cuff defects. II. Synovial fluids studies. Arthritis Rheum 24:474–483Google Scholar
  6. 6.
    Ishikawa K, Ohira T, Sakata H (1984) Effects of intraarticular injection of halopredone diacetate on the articular cartilage of rabbit knees: A comparison with methylprednisolone acetate. Toxicol Appl Pharmacol 75:423–436Google Scholar
  7. 7.
    McCarty DJ, Halverson PB, Carrea GF, Brewer BJ, Kozin F (1981) “Milwaukee shoulder”-association of microspheroids containing hydroxyapatite crystals, active collagenase, and neutral protease with rotator cuff defects. I. Clinical aspects. Arthritis Rheum 24:467–473Google Scholar
  8. 8.
    Neer CS II (1972) Anterior acromioplasty for the chronic impingement syndrome in the shoulder. A preliminary report. J Bone Joint Surg [Am] 54:41–50Google Scholar
  9. 9.
    Neer CS II (1983) Impingement lesions. Clin Orthop 173:70–77Google Scholar
  10. 10.
    Neer CS II, Graig EV, Fukuda H (1983) Cuff-tear arthopathy. J Bone Joint Surg [Am] 65:1232–1244Google Scholar
  11. 11.
    Ohira T, Ishikawa K (1986) Hydroxyapatite deposition in articular cartilage by intra-articular injections of methylprednisolone. A histological, ultrastructural, and X-raymicroprobe analysis in rabbits. J Bone Joint Surg [Am] 68:509–520Google Scholar
  12. 12.
    Ohira T, Ishikawa K (1987) Hydroxyapatite deposition in osteoarthritic articular cartilage of the proximal femoral head. Arthritis Rheum 30:651–660Google Scholar
  13. 13.
    Paul H, Reginato AJ, Schumacher HR (1983) Alizarin red S staining as a screening test to detect calcium compounds in synovial fluid. Arthritis Rheum 26:191–200Google Scholar
  14. 14.
    Uhthoff HK (1975) Calcifying tendinitis: an active cellmediated calcification. Virchows Arch [A] 366:51–58Google Scholar
  15. 15.
    Uhthoff HK, Sarkar K, Maynard JA (1976) Calcifying tendinitis: a new concept of its pathogenesis. Clin Orthop 118:164–168Google Scholar
  16. 16.
    Williams TJ, Peck MJ (1977) Role of prostaglandinmediated vasodilation in inflammation. Nature 270:530–532Google Scholar
  17. 17.
    Wilson JN (1959) Spontaneous haemarthrosis in osteoarthritis of knee. Br Med J 2:1327–1328Google Scholar
  18. 18.
    Woolf AD, Cawston TE, Dieppe PA (1986) Idiopathic haemorrhagic rupture of the shoulder in destructive disease of the elderly. Ann Rheum Dis 45:498–501Google Scholar

Copyright information

© Springer-Verlag 1988

Authors and Affiliations

  • K. Ishikawa
    • 1
  • T. Ohira
    • 1
  • K. Morisawa
    • 1
  1. 1.Department of Orthopedic SurgeryKumamoto University Medical SchoolKumamoto-ShiJapan

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