Snoddy Mark C, Lee Donald H, Kuhn John E
Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
J Shoulder Elbow Surg. 2017 Mar;26(3):544-552. doi: 10.1016/j.jse.2016.10.015. Epub 2017 Jan 19.
Charcot arthropathy of the shoulder and elbow is a rare disease process initially described in the 1700s; however, it was not until the 19th century that physicians understood its association with other disease processes such as cervical spine pathology and diabetes. A primary complaint is painful or painless joint dysfunction, meaning the orthopedic surgeon is regularly the first physician to evaluate the patient. Frequently, the condition of these patients is misdiagnosed. Although the pathogenesis of the disease is controversial, the etiology is commonly due to syringomyelia. The key to successful management is a thorough history and examination along with a workup including specific laboratory testing and imaging to rule out other disease processes. Most neuropathic shoulders and elbows have historically been managed conservatively because of poor outcomes with operative interventions. Newer data have emerged hinting that early neurosurgical intervention can stabilize this degenerative process. If clinical and radiographic stabilization occurs, recent studies have outlined surgical indications that can provide surgeons with a guide as to patients in whom successful operative outcomes can be achieved in the face of failed conservative management.
肩肘夏科氏关节病是一种罕见的疾病过程，最初于18世纪被描述；然而，直到19世纪医生才了解到它与其他疾病过程如颈椎病变和糖尿病的关联。主要症状是疼痛或无痛性关节功能障碍，这意味着骨科医生通常是首位评估患者的医生。这些患者的病情常常被误诊。尽管该病的发病机制存在争议，但其病因通常是脊髓空洞症。成功治疗的关键是详细的病史和体格检查，以及包括特定实验室检查和影像学检查在内的评估，以排除其他疾病过程。由于手术干预效果不佳，历史上大多数神经性肩肘疾病都采用保守治疗。新的数据表明，早期神经外科干预可以稳定这种退行性过程。如果实现了临床和影像学稳定，最近的研究已经概述了手术指征，可为外科医生在面对保守治疗失败时能够取得成功手术结果的患者提供指导。
