Abstract / Summary
Abstract Background Acute shoulder gout concurrent with rotator cuff injury is extremely rare in clinical practice. This disease presents non-specific clinical manifestations and conventional imaging features, resulting in a high misdiagnosis rate. Relevant clinical studies remain limited. We report a typical case herein, summarize the core causes of misdiagnosis, and refine standardized diagnostic and therapeutic principles, aiming to provide evidence-based references for precise clinical diagnosis and management of similar conditions. Case presentation A 52-year-old male patient presented with abrupt severe right shoulder pain lasting 2 days. He had a long-standing history of gout involving the first metatarsophalangeal and knee joints with poorly controlled serum uric acid. Laboratory tests revealed significantly elevated serum uric acid and systemic inflammatory markers. Preoperative computed tomography (CT) and magnetic resonance imaging (MRI) initially indicated calcific tendinitis, and symptoms failed to resolve after routine conservative treatment. Arthroscopic exploration revealed extensive chalky white monosodium urate (MSU) crystal deposition on the acromial and tendinous surfaces, combined with a partial supraspinatus tendon tear. Intraoperative synovectomy, thorough crystal debridement, and rotator cuff repair were performed. Postoperative histopathology confirmed the diagnosis of shoulder gouty arthritis. Standard long-term urate-lowering therapy was administered postoperatively, achieving significant pain relief. At the 3-month follow-up, serum uric acid was stably controlled, and full shoulder function was recovered. Conclusion Acute shoulder gout combined with rotator cuff tear is a rare clinical entity that is frequently misdiagnosed as calcific tendinitis. High clinical suspicion for shoulder gout should be maintained in patients with hyperuricemia or a gout history presenting with acute severe shoulder pain. Arthroscopic debridement combined with rotator cuff repair, followed by standardized long-term urate-lowering therapy and adjuvant traditional Chinese medicine intervention, can substantially improve long-term clinical outcomes.