Shoulder gout. And it could also happen outside its main joint



This page about shoulder gout was first reviewed or updated on 14 August 2018  

The good news about shoulder gout is that there is only a small possibility that a gout sufferer will end up with gout in the shoulder, and an even smaller one that it would be the sufferer’s first gout attack. Only if you had previously had an accident in your shoulder would the chances rise a little. So if you wonder whether you have gout in the shoulder, you need to ask yourself that.

So gout in the shoulder is unusual. It is far more likely that a pain in the shoulder is something else. One study conducted in Taiwan in 2017 (1) is one of the very few studies to tell us something about gout in the shoulder. In a large population of gout sufferers, 32,723, compared to 65,446 other people shoulder rotator cuff damage requiring repair was found in the gout population at the rate of 31 per 100,000 person years. This is not the only shoulder damage that would be caused by gout so the total shoulder damage from the gout population would be larger than this number. But it’s still small.

However, it may be on the rise because gout world wide is rising. And our statistics for views of this page and the second shoulder gout page shows these pages are much more viewed than I imagined when I wrote them.

The joints in your shoulder

Since you know your arm is connected to your shoulder by joint - the glenohumeral joint - you may be tempted to think there is only one shoulder joint. But in fact there are three more. Next, the acromio-clavicular joint is found where the collarbone (clavicle) meets the acromion on the shoulder blade. Thirdly there is the sterno-clavicular joint where the collarbone meets the chest bone, and lastly the scapulo-thoracic joint where the shoulder blade (scapula) meets the back of the chest.

DIAGNOSING SHOULDER GOUT

If you are visiting this page because you have shoulder pain – which is very common - and you think it could be caused by gout, take note. These are the features of gout pain:   

* inflamed/swelling  * sore * reddish/purple skin  * tender  * pain arrives rapidly as a sharp stabbing pain

Compare these features with yours. Additionally if you have shoulder gout, it will cause limited shoulder and arm movement but so will other shoulder afflictions. However, other pains, with the exception of pseudo gout pain which is similar to gout pain, will not be exactly the same.

Shoulder gout can be difficult to diagnose. Finding out exactly can drag on for a long time.  Other likely shoulder pains which are not caused by gout is a list “as long as your arm;” viz bursitis, adhesive capsulitis (frozen shoulder), rheumatoid arthritis, pseudo gout, osteoarthritis , septic arthritis, injury, PVNS, and others.

So there are many afflictions that can get confused with gout, especially pseudo gout. Experts say pseudo gout  is more likely in the shoulder than gout. Pseudo gout is caused by different types of crystals – calcium pyrophosphate ones - as opposed  to gout’s uric acid crystals. But the features of pseudo gout pain are very similar to gout’s.

What parts of the shoulder  get affected most by gout and pseudo gout ? An Italian study (2) in 2013 found that the supraspinatus tendon muscle, one of the four in the rotator cuff, is the most often affected. Next is the fibrocartilage of the  acromio-clavicular joint And seven times more by pseudo gout than by gout in this study.

So, in this study at least, the shoulder's main joint, the glenohumeral joint, which links your shoulder blade to your upper arm bone, was not the spot which gout went for the most. It came in third despite the presence of synovial fluid in this joint that gout crystals go for.

The most frequent abnormality was the presence of osteophytes in 80% of pseudo (CPPD disease) gout shoulders and 60% of gout patients' shoulders.

Four steps to diagnosing shoulder gout

To assume you might have shoulder gout is a practical assumption if you already have gout in other body places because a first time gout attack in the shoulder is rare. If you don't have gout or pseudo gout, rheumatoid arthritis is the most common affliction of the ball- and-socket glenohumeral joint.

(1)  Examine your affected-by-gout-pain area (s) of the body for the five features of pain listed above.

(2)  Find out if you have crystals and if they are gout’s MSU crystals  - by aspiration (arthrocentenis).

(3)  Take a blood uric acid level reading. Above about 7.0 mg/dL means a level at which gout can occur. Below, and it is unlikely.

(4)  Do an MRI scan to look for tophi in the rotator cuff or elsewhere in the shoulder

Gout and pseudo gout differences 

One way of knowing if its gout or pseudo gout is to identify the crystals as MSU gout crystals, using a special polarising (polarizing) microscope to examine removed synovial joint fluid. Knowing the crystals are gout crystals will also distinguish gout from the other shoulder afflictions which will not have these crystals.  

Since pseudo gout affects the shoulders as much, or more, than gout you need to be able to tell the difference. 

Here are differences. Gout crystals are needle shaped and made from monosodium urate (uric acid). But pseudo gout crystals are rhomboid or square shaped and made from calcium pyrophosphate. A further difference is that pseudo gout crystals can usually be viewed on an X-ray machine whereas gout's MSU crystals cannot. Although bones and joints damaged by gout can be seen.  Tophi which is caused by gout, not  pseudo gout, can be seen by an MRI scan.When examined under the microscope an experienced practitioner can tell the difference between the the sorts of crystals.

Finally if someone’s uric acid level is high, that is an exclusive sign of gout, but not its confirmation. People with pseudo gout could have normal uric acid levels but it is very unlikely gout patients would. As far as the features of pain are concerend pseudo gout pain is similar to gout's. No diagnosis help there.

It gets complicated when, as sometimes happens, deposited crystals in the synovial joint fluid are both gout and pseudo gout types.The polarising (polarizing) microscope operator needs experience to spot the differences.

More about gout and pseudo gout on this best-gout-remedies.com page


VIDEO - THE REMOVAL OF SYNOVIAL FLUID PART OF ASPIRATION 

Removing synovial fluid from the shoulder and examining it for gout crystals is the gold standard of tests for gout. Here the doctor is performing a shoulder joint aspiration (aka arthrocentesis). That is,  removing synovial fluid for a septic arthritis check, but he could also be removing it to look for MSU gout crystals in the synovial fluid.( NB This video is foe education not medical advice).


CONTACT US ABOUT SHOULDER GOUT

Shoulder gout is a somewhat under researched and written topic in gout. If you have suffered from it, or thought you did, please use the form below to send us details which we can present to our visitors.

RELATED PAGES

Go to our second page about shoulder gout It discusses its causes and treatment, gout in the rotator cuff in the shoulder, and the problem of tophi in the shoulder. Plus a tip gives advice about what to do.

Visit our index page for all our gout in body areas - toes, ankles, wrists etc. pages

Read about Living with gout and Dealing with gout

References

(1)  Huang SW, Wu CW, Lin LF, Liou TH, Lin HW  Gout can increase the risk of receiving rotator cuff tear repair surgery Am J Sports Med2017 Aug;45(10):2355-2363. doi: 10.1177/0363546517704843. Epub 2017 May 9.

(2) Filippucci E, Delle Sedie A, Riente L, Di Geso L, Carli L, Ceccarelli F, Sakellariou G, Iagnocco A, Grassi W. Ultrasound imaging for the rheumatologist. XLVII. Ultrasound of the shoulder in patients with gout and calcium pyrophosphate deposition disease.
Clin Exp Rheumatol. 2013 Sep-Oct;31(5):659-64. Epub 2013 Sep 18.




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