title: Efficacy of tidal irrigation in Milwaukee shoulder syndrome.
abstract: OBJECTIVE
  To assess the efficacy of tidal irrigation in patients with Milwaukee shoulder syndrome (MSS).
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Rheumatology, University of Pavia, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy.
authors.forename: Oscar
authors.initials: O
authors.lastname: Epis
authors.forename: Roberto
authors.initials: R
authors.lastname: Caporali
authors.forename: Carlo A
authors.initials: CA
authors.lastname: Scirè
authors.forename: Eleonora
authors.initials: E
authors.lastname: Bruschi
authors.forename: Eleonora
authors.initials: E
authors.lastname: Bonacci
authors.forename: Carlomaurizio
authors.initials: C
authors.lastname: Montecucco
mesh_terms: D002130:Calcium Phosphates / Q000378:metabolism; D002805:Chondrocalcinosis / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D003460:Crystallization; D004359:Drug Therapy, Combination; D006801:Humans; D007592:Joint Diseases / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D008775:Methylprednisolone / Q000627:therapeutic use; D012785:Shoulder Joint / Q000000981:diagnostic imaging; D013577:Syndrome; D007507:Therapeutic Irrigation / Q000379:methods; D014148:Tranexamic Acid / Q000627:therapeutic use; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D002130:Calcium Phosphates; D014148:Tranexamic Acid; C020243:calcium phosphate; D008775:Methylprednisolone