Neuropathic Arthropathy of the Shoulder (Charcot Shoulder)

Aaron B. Cullen, MD, PhD; Onder Ofluoglu, MD; Rakesh Donthineni, MD

Disclosures
In This Article

Introduction, Case History, and Diagnosis

Neuropathic osteoarthropathy, otherwise known as Charcot neuroarthropathy, is a chronic, degenerative arthropathy and is associated with decreased sensory innervation. Numerous causes of this arthropathy have been described. Herein, we report a case of neuropathic osteoarthropathy of the shoulder, also known as Charcot shoulder, secondary to syringomyelia. The pathophysiology, clinical findings, and diagnostic work-up options are discussed.

The patient is a 36-year-old, wheelchair-dependent man who presented with left shoulder pain and weakness. He had normal use of both upper extremities until 3 months prior, at which time he began having left shoulder dull pain. The patient also has been noticing progressive weakness and difficulty with range of motion in his left shoulder. This has impaired his ability to use his wheelchair. The patient denies any fevers, chills, weight loss, anorexia, or other constitutional symptoms. Past medical history is significant for multiple injuries from a motorcycle accident nearly 20 years previously, and having multiple operations on his lower extremities. He has no history of spinal surgery. He does not take medications nor does he smoke.

On physical examination, the patient is a healthy-appearing male in a wheelchair. He has full range of motion of his cervical spine. He has full range of motion, 5/5 strength, and intact sensation of his right upper extremity. Examination of the patient's left upper extremity reveals normal skin and no abnormal masses. There is no supraclavicular lymphadenopathy. Active abduction is limited to 80º. He has 4/5 biceps strength, 5/5 triceps strength, and 5/5 motor strength distally in the left upper extremity. He has a 2+ radial pulse, and his median, ulnar, and radial nerves are all intact at the level of the hand. With passive range of motion, there is motion through the humerus distal to where the shoulder joint would be expected.

Radiographic evaluation shows complete destruction of the left humeral head with fragmentation (Figure 1). The scapula appears intact.

Anterior-posterior radiograph of left shoulder. There is complete destruction of the left humeral head with fragmentation. The distal clavicle and scapula appear intact.

Neuropathic osteoarthropathy of the shoulder.

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