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Idiopathic destructive arthritis of the shoulder.

A 50-year-old woman presented with progressive onset bilateral shoulder pain. She had no previous injury to or problems with her shoulders. Nine months previously, she noted that decreased range of motion of the shoulders became more persistent and accentuated. On physical examination, the patient demonstrated no atrophy or deformity in the shoulders but her range of motion was restricted. Motion study of the right shoulder showed abduction to be 80”, external rotation 10”, internal rotation 0”, forward flexion 70” and that of the left shoulder showed abduction 50”, external rotation 10”, internal rotation 10”, and forward flexion 45”. She had no neck pain, weakness, or sensory deficits. Laboratory investigations including erythrocyte sedimentation rate and serology (syphilis serodiagnostic) were non contributory. Plain radiographs revealed a destructive process at the humeral heads with flattening and deformity (Picture 1: panel A and B). There was no radiographic sign of articular or periarticular calcification. Computed tomography scan showed bilateral glenohumeral chondrolysis with subchondral cystic degeneration (Picture 2: panel A, B, C and D) and subluxation of the left humerus. The possibility of a neuropathic joint was raised but spinal magnetic resonance imaging showed no evidence of syringomyelia. Synovial tissue studies from biopsies of the shoulder revealed some degree of synovial cell hyperplasia with little or no inflammatory cell infiltrate. Diagnosis of bilateral idiopathic destructive arthritis (IDA) of the shoulder was made. IDA is a fascinating form of destructive arthritis which bears resemblance to other neuropathic-like arthropathies (1). This arthropathy has remarkable characteristics: its radiographic features are destructive and atrophic, and its clinical presentation, is more or less distinctive (2). Much needs to be