Neuropathic arthropathy of the shoulder caused by syringomyelia: a case report

Abstract

Neuropathic or Charcot arthropathy is a chronic degenerative disease that causes joint destruction in patients with abnormal sensation and proprioception. Charcot shoulder is rare and its most common cause is syringomyelia. Patients present insidiously with joint instability, swelling and dysfunction. Pain may not be present due to sensory loss. The key to successful management is early diagnosis by a thorough history, physical examination and imaging after exclusion of inflammatory, infectious and malignant etiology. Most commonly, Charcot shoulders are managed conservatively, although surgical intervention has recently proven to be a promising treatment for recovering function in selected patients. We present a 52-year-old female with chronic complaints of sensory loss and swelling of her right upper limb that progressively evolved for shoulder pain and marked dysfunction, which led to the diagnosis of syringomyelia associated with Chiari I malformation and for what she had undergone posterior fossa craniectomy. Considering her past medical history and after exclusion of other etiology, she was diagnosed with shoulder neuropathic arthropathy. She initiated conservative treatment but symptomatic and functional improvement was poor, highlighting the importance of early diagnosis and management of these patients.