Teaching NeuroImages: Neuropathic elbow arthropathy due to syringomyelia
Correspondence & reprint requests to Dr. Nair: .Neurology (Impact Factor: 8.29). 09/2012; 79(12):e102. DOI: 10.1212/WNL.0b013e31826aad39
A 45-year-old woman presented with 3 months of left elbow swelling and minimal pain (figure, A). She did not remember any upper extremity injury. On exami-nation, she had arthritis of left elbow, wasting of small muscles of the hand, depressed biceps and supinator jerks, and decreased pain and temperature sensation over C5 to T1 dermatomes bilaterally. Tests for syphi-lis, diabetes mellitus, and leprosy were negative. Left el-bow X-ray revealed joint destruction, disorganization, sclerosis, and debris formation (figure, B), Cervical spine MRI revealed syringomyelia from C2 to T3 vertebra level (figure, C and D). She was diagnosed with neuropathic left elbow arthropathy due to syringomyelia. 1,2
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ABSTRACT: Neuropathic arthropathy, or Charcot joint, is a progressive degenerative arthritis with multiple causes, syringomyelia being the second most common cause after diabetes mellitus. The shoulder is the most frequently affected joint in the upper limbs, and neuropathic arthropathy of the elbow is very infrequent. Ulnar neuropathy is a complication that can occur in patients with neuropathic arthropathy of elbow due to nerve entrapment causing by joint disintegration. There are very few previous case reports of ulnar neuropathy secondary to neuropathic arthropathy of the elbow due to syringomyelia. This report describes the case of a 61-year-old woman with ulnar neuropathy due to neuropathic arthropathy of the elbow caused by cervicothoracic syringomyelia.