Shoulder and Elbow Cases to Consider.
Last updated Friday, February 11, 2005
Figure 1 - Destruction of the humeral head with an associated soft tissue mass Figure 2 - Cervicothoracic syrinx Charcot arthropathyClinical presentation A 43 year old right-hand-dominant male, with a history of a
nonspecific injury to his left shoulder while skiing 15 years ago,
presented to the University of Washington Shoulder and Elbow Service
complaining of crepitus in his left shoulder. Approximately 3 to 4
weeks prior to presentation, the patient noted acute onset of painless
and progressive left shoulder swelling. The patient's past medical and
surgical histories were otherwise unremarkable.
Physical examination was remarkable for a 10 x 15 cm nontender mass
in the anterolateral aspect of his left shoulder. Neurovascular
examination was remarkable only for a vague, nondermatomal decrease in
pinprick sensation in his left upper extremity. Proprioception and
vibration sensation were preserved.
Plain radiographs of the left shoulder revealed destruction of the
humeral head with an associated soft tissue mass (see figure 1).
Laboratory tests were unremarkable. Management The differential diagnosis included Charcot joint, septic arthritis,
and neoplasm. The patient was taken to the operating room for open
biopsy of his left shoulder mass. Cultures were negative. Histological
examination showed chronic inflammation, reactive new bone formation,
and fibrosis suggestive of neuropathic arthropathy. Subsequently, the
patient had an MRI of the cervical spine which demonstrated a
cervicothoracic syrinx (see figure 2).
The patient was evaluated by the Neurosurgery Service and underwent a syringoperitoneal shunt.
Since arthroplasty and arthrodesis in this group of patients have a
historically high failure rate, no further surgical intervention in
planned. The patient has been educated as to the disease process as
well as conservative treatment to maximize his function. Disclaimer
This resource has been provided by the University of Washington Department of Orthopaedics and Sports Medicine as general information only. This information may not apply to a specific patient. Additional information may be found at http://www.orthop.washington.edu or by contacting the UW Department of Orthopaedics and Sports Medicine.
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