summary Neuropathic Charcot Joint of the Elbow is a chronic and progressive joint disease most commonly caused by syringomyelia leading to the destruction of the elbow joint and surrounding bony structures. Diagnosis is made with radiographs of the elbow and supplemented with cervical spine MRI to assess for a syrinx. Treatment should be individualized based on degree of functional limitation and underlying neurological condition. Neurosurgical decompression is indicated in the presence of a syrinx. Epidemiology Incidence rare condition in the upper extremity (~ 40 cases reported in literature) Anatomic location elbow (this topic) shoulder foot & ankle (see diabetic Charcot foot) Etiology Pathophysiology syrinx formation syrinx formation (fluid-filled cavity) in spinal cord causes damage to the decussating fibers of the lateral spinothalamic tract leading to loss of pain and temperature sensation login to view 1 more bullet as syrinx enlarges, damage to dorsal column and anterior horn of spinal cord lead to areflexia, loss of motor strength and muscle atrophy. joint destruction neurotrauma login to view 2 more bullets neurovascular login to view 2 more bullets Genetics molecular biology RANK/RANKL/OPG triad pathway is thought to be involved Associated conditions orthopedic conditions ulnar neuropathy medical conditions & comorbidities syringomyelia login to view 3 more bullets Arnold-Chiari malformation login to view 1 more bullet Hansen's disease (leprosy) login to view 1 more bullet neurosyphilis (tabes dorsalis) login to view 2 more bullets diabetes login to view 1 more bullet Presentation Symptoms swollen elbow 50% have pain, 50% are painless loss of function Physical exam inspection swollen, warm, erythematous joint mimics infection atrophy due to ulnar nerve entrapment login to view 3 more bullets motion loss of active motion is most common finding login to view 1 more bullet elbow joint may be mechanically unstable loss of passive motion indicates mechanical block neurovascular a neurologic evaluation is essential ulnar nerve entrapment at the elbow very common login to view 2 more bullets Imaging Radiographs recommended views standard views of affected joint login to view 1 more bullet findings early changes login to view 1 more bullet late changes login to view 7 more bullets MRI indications MRI of cervical spine to rule out syrinx when neuropathic elbow arthropathy is present Bone scan technetium bone scan findings login to view 1 more bullet indium WBC scan findings login to view 2 more bullets Studies Labs ESR and WBC can be elevated making it difficult to differentiate from osteomyelitis EMG/NCS helpful for confirming ulnar neuropathy associated with diagnosis Histology synovial hypertrophy detritic synovitis (cartilage and bone distributed in synovium) Differential Osteomyelitis/septic joint difficult to distinguish from osteomyelitis based on radiographs and physical exam common findings in both conditions login to view 3 more bullets unique to Charcot joint disease login to view 2 more bullets Treatment Nonoperative rest, NSAIDs, functional bracing, restriction of activity and treatment of underlying disease indications login to view 1 more bullet outcomes login to view 1 more bullet intra-articular corticosteroid injection indications login to view 1 more bullet Operative neurosurgical decompression indications login to view 1 more bullet outcomes login to view 2 more bullets peripheral nerve neurolysis indications login to view 2 more bullets outcomes login to view 1 more bullet elbow arthrodesis indications login to view 1 more bullet outcomes login to view 1 more bullet total joint replacement indications login to view 2 more bullets outcomes login to view 1 more bullet Techniques Rest, NSAIDs, functional bracing, restriction of activity and treatment of underlying disease technique functional bracing login to view 1 more bullet Intra-articular corticosteroid injection technique ulnohumeral joint injection is considered most effective Neurosurgical decompression technique neurosurgical management has been reported to consist of 1 or more of the following login to view 4 more bullets Peripheral nerve neurolysis technique cubital tunnel release must be performed with careful soft tissue dissection due to severely altered anatomy noted in patients with charcot elbow Elbow arthrodesis technique optimal position login to view 2 more bullets Complications Ulnar nerve entrapment most common complication of charcot elbow Infection risk factors high risk with surgical intervention without management of underlying condition Upper extremity DVT risk factors any surgical intervention