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Loss of blood supply to the humeral head
12%
201/1623
Fluid filled cavity in the spinal cord
61%
984/1623
Distant primary tumor with aggressive features
8%
129/1623
Tumor consisting of primarily cartilage cells
16%
264/1623
Tumor consisting of primarily osseous cells
2%
32/1623
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A syrinx, or a fluid-filled cavity in the spinal cord, is the most common cause of Charcot degeneration of the shoulder. Charcot degeneration of the shoulder most commonly occurs following syrinx formation in the spinal cord. The creation of a fluid-filled sac in the spinal cord results in damage to the decussating fibers of the lateral spinothalamic tract, which results in loss of pain and temperature sensation. As such, 25% of patients will develop Charcot changes secondary to repetitive microtrauma and abnormal pressures encountered by the shoulder. Diagnosis is initially made with plain radiographs, however, an MRI of the cervical spine should be obtained to evaluate for a syrinx. Drvaric et al report a case of neuropathic arthropathy of the shoulder that occurred secondary to syringomyelia. They emphasize the importance of MRI imaging in the evaluation of these patients. They conclude that neuropathic arthropathy should be considered in the evaluation of patients with shoulder pain or instability. Hatzis et al review neuropathic arthropathy of the shoulder. They report the inciting cause to be syringomyelia in 5/6 shoulders, with alcoholism being the cause of the last neuropathic joint. They conclude that MRI should be obtained in these patients as there is a high likelihood that a syrinx will be identified. Figure A shows neuropathic destruction of the right shoulder with destruction to both the glenoid and the proximal humerus. Incorrect Answers: Answer 1: Loss of the blood supply to the humeral head would result in AVN, which would be identified with sclerosis and flattening of the humeral head on radiographs. Answer 3: Metastatic lesions may have a variable appearance on plain film, however, the obliterative process seen on both sides of the glenohumeral joint is more indicative of a neuropathic diagnosis. Answer 4: While tumors should be in the differential, the radiographic appearance of the shoulder is indicative of neuropathic destruction. A bony tumor that is cartilaginous in nature would show increased calcification throughout the lesion, which is not appreciated here. Answer 5: Tumors of a bony origin, often show increased ossification throughout the lesion.
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