F Hollman¹*, EGJ Thijssen², CEP Van Munster³, EMJ Cornips⁴, JJC Arts^1,2 and PZ Feczko²

¹Department of Orthopaedic Surgery, Maastricht University Medical Center, P. Debyelaan, HX Maastricht, The Netherlands
²Laboratory for Experimental Orthopaedics, Maastricht University, Universiteitssingel, ER, Maastricht, The Netherlands
³Department of Neurology, Amphia, Molengracht, Breda, The Netherlands
⁴Department of Neurosurgery, Maastricht University Medical Center, P. Debyelaan, HX Maastricht, The Netherlands

*Corresponding Author: F Hollman, Department of Orthopaedic Surgery, Maastricht University Medical Center, P. Debyelaan, HX Maastricht, The Netherlands.

Received: November 03, 2022; Published: November 21, 2022

Abstract

Background: Charcot arthropathy may occur in the upper extremities as a result of syringomyelia or even multiple sclerosis. However, due to late diagnosis, function of the affected joint is often lost. This article shows two cases of patients with Charcot arthropathy of the upper extremities.

Case presentations: The first case describes a Charcot arthropathy of the elbow, thought to be a result of white matter lesions in multiple sclerosis. The second case describes a Charcot arthropathy of the shoulder as a result of syringomyelia. Both cases show the importance of a multidisciplinary approach in the diagnostic process of Charcot arthropathy, in which collaboration between at least an orthopaedic surgeon, neurologist, neurosurgeon and radiologist is recommended.

Discussion and Conclusions: A multidisciplinary approach is essential for the treatment process in Charcot arthropathy. Not only for the completeness, but also for the duration of the diagnostic process. This is of great importance, since - as discussed above - early diagnosis of Charcot arthropathy may prevent further destruction of the affected joint and thus preserve function of the joint. Therefore, it is important to redirect patients to a multidisciplinary health care centre. It is recommended to focus treatment on preservation of joint function in addition to treatment of the underlying neurological cause.

Keywords: Charcot; Shoulder; Elbow; Mutiple Sclerosis; Syringomyelia

References

1. Belkin NS LG. “Neuropathic Arthropathy of the Glenohumeral Joint as the presenting symptom of a Cervical Syrinx: A Case Report”. University of Pennsylvania Orthopaedic Journal (2015): 25.
2. Deng X WL., et al. “Neuropathic arthropathy caused by syringomyelia”. Journal of Neurosurgery: Spine3 (2013): 303-309.
3. Galli M SG., et al. “Surgical treatment for chronic Charcot neuroarthropathy”. Foot (Edinb) 36 (2018): 59-66.
4. Pitocco D SG., et al. “Charcot Neuroarthropathy: From the Laboratory to the Bedside”. Current Diabetes Reviews 1 (2019): 62-72.
5. Vitiello R PA., et al. “Clinical evaluation of tibiocalcaneal arthrodesis with retrograde intramedullary nail fixation in diabetic patients”. Acta Orthopaedica et Traumatologica Turcica 3 (2020): 255-261.
6. Cianni L BM., et al. “Arthrodesis in the Charcot foot: a systematic review”. Orthopedic Reviews 12 (2020): 8670.
7. Rosskopf AB LC., et al. “The Charcot foot: a pictorial review”. Insights into Imaging 1 (2019): 77.
8. Yanık B TS and Seçkin B. “Neuropathic arthropathy caused by Arnold-Chiari malformation with syringomyelia”. Rheumatology International 4 (2004): 238-241.
9. Crowther MAA BS. “Neuropathic shoulder in syringomyelia treated with resurfacing arthroplasty of humeral head and soft-tissue lining of glenoid: A case report”. Journal of Shoulder and Elbow Surgery 6 (2007): 38-40.
10. Kleinschmidt-DeMasters BK NJ. “Multiple sclerosis with hydromyelia demonstrated at autopsy”. Journal of the Neurological Sciences 1 (1996): 185-188.
11. Solaro C UA., et al. “Multiple sclerosis and non-communicating syringomyelia: a casual association or linked diseases?” Acta Neurologica Scandinavica 4 (1999): 270-273.
12. Weier K NY., et al. “Non-communicating syringomyelia: a feature of spinal cord involvement in multiple sclerosis”. Brain 7 (2008): 1776-1782.
13. S M. “The Pathogenesis of Diabetic Charcot Joints”. Iowa Orthopedic Journal 12 (1992): 63-70.
14. Kwee IL NT. “Syrinx formation in multiple sclerosis”. The British Journal of Radiology 696 (1985): 1206-1208.
15. Sahoo Pabitra Kumar MM and Mohanty Ram Narayan. “Charcot’s Arthropathy of Elbow Associated with Type I Arnold-Chiari Malformation - A Case Report”. IJPMR 4 (2015): 125-128.
16. Nacir B., et al. “Neuropathic arthropathy progressing with multiple joint involvement in the upper extremity due to syringomyelia and type I Arnold-Chiari malformation”. Rheumatology International 7 (2010): 979-983.
17. Bocca LF., et al. “Teaching Neuro Images: The Charcot shoulder: Chiari malformation with syringomyelia associated with arthropathy”. Neurology 4 (2017): e38.
18. Noort JBBRAV. “Charcot schouder bij een patiënt met syringomyelie”. Nederlands Tijdschrift Voor Orthopaedie 3 (2009): 122-125.
19. Bolder JB Br and Van Noort A. “Charcot schouder bij een patiënt met syringomyelie”. Nederlands Tijdschrift voor Orthopaedie 3 (2009): 122-125.
20. Hendrikx S HI and Koehler PJ. “Twee patiënten met syringomyelie en een charcot-gewricht”. Ned Tijdschr Geneeskd 151 (2007): 1737-1742.
21. Kisabay ASZ SS., et al. “A Pre- and Postoperative Evaluation of Multiple Joint Involvement as the Initial Finding of Cervical Syringomyelia and Neuropathic Arthropathy”. Turkish Journal of Rheumatology 4 (2013): 271-277.
22. Kumar SP NM. “Charcot’s Arthropathy of Elbow Associated with Type I Arnold-Chiari Malformation - A Case Report”. IJPMR 4 (2014): 125-128.
23. Schoch B WJ-D., et al. “Is shoulder arthroplasty an option for charcot arthropathy?” International Orthopaedics 12 (2016): 2589-2595.
24. Nacir B ACS., et al. “Neuropathic arthropathy progressing with multiple joint involvement in the upper extremity due to syringomyelia and type I Arnold-Chiari malformation”. Rheumatology International 7 (2010): 979-983.

Citation

Citation: F Hollman., et al. “Charcot Arthropathy of the Upper Extremity in Relation with Multiple Sclerosis or Syringomyelia. A Case Report of Two Rare Cases and Review of the Literature”. Acta Scientific Orthopaedics 5.12 (2022): 161-168.

Copyright

Copyright: © 2022 F Hollman., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.