Review Question - QID 1273

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Neuropathic (Charcot) Joint of Shoulder Imaging MRI QID: 1273 (OBQ04.168)

QID 1273 (Type "1273" in App Search)

A 50-year-old wheelchair-bound male with a history of traumatic spinal cord injury presents with 6 months of progressive, painless left shoulder weakness and decreased range of motion. He is afebrile and CBC, ESR, and C-reactive protein levels are normal. A radiograph is shown in Figure A. Early management should include:

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HIV testing

10%

188/1795

cervical spine MRI

77%

1378/1795

repeat ESR, C-reactive protein, CBC

81/1795

emergent open reduction and internal fixation

41/1795

emergent irrigation and drainage

102/1795

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This patient has a history of spinal cord injury and presents with an upper extremity neuropathic arthropathy, so a syrinx is highly suspected. Figure A demonstrates a Charcot left shoulder.

Hatzis et al demonstrated that of 6 patients with Charcot shoulder, 5 of the 6 patients were found to have syrinx on MRI of the spine as the underlying cause. Therefore, all patients with shoulder neuropathic arthropathy should receive an MRI of the cervical spine.

As discussed by Guille et al., other causes of neuroarthropathy of the shoulder include Chiari malformation, syphilis and diabetes. They reported on a rare case of Charcot shoulder neuroarthropathy from familial sensory neuropathy.