Park Min Kyu, Ashwood Neil, Dekker Andrew P, Stammer Adam T, Sidhu Gur Aziz
Trauma and Orthopaedics, University of Leicester, Leicester, GBR.
Trauma and Orthopaedics, University Hospitals Derby and Burton, Derby, GBR.
Cureus. 2024 Jul 17;16(7):e64776. doi: 10.7759/cureus.64776. eCollection 2024 Jul.
Charcot neuroarthropathy (CN) is a chronic degenerative disorder of bones and joints, mostly associated with diabetes mellitus and human immunodeficiency virus. CN of the upper limb is rare, with only 58 case reports identified on PubMed with the majority of cases being closely associated with syringomyelia. Very rarely, cervical spondylotic myelopathy (CSM) is associated with CN of the upper limb; with very few literature reporting this association. This case report presents a rare case of Charcot arthropathy of the shoulder caused by CSM. A 57-year-old female presented to the emergency department following trauma to the right shoulder. On clinical examination, there was evidence of tenderness, extensive swelling, and bruising with a lack of range of motion along with numbness in the right arm and legs. Through radiographic and laboratory investigations, a diagnosis of CN secondary to CSM was made. A reverse total shoulder arthroplasty was performed however, this was complicated at two weeks with an atraumatic glenoid fracture and dislocation. First-stage revision surgery was then performed to allow fracture healing pending second-stage revision surgery. This report provides insight into the very rare possibility of the association of CN of the shoulder with CSM. A review of the literature suggests reverse shoulder arthroplasty is the gold standard for cases of severe bone and soft tissue damage. When undergoing investigations for Charcot neuroarthropathy, physicians must undertake a full detailed history along with a detailed neurological examination and imaging of the cervical spine to not miss the association with CSM.
夏科氏神经关节病（CN）是一种骨骼和关节的慢性退行性疾病，主要与糖尿病和人类免疫缺陷病毒有关。上肢夏科氏神经关节病较为罕见，在PubMed上仅发现58例病例报告，其中大多数病例与脊髓空洞症密切相关。极罕见的情况下，颈椎病性脊髓病（CSM）与上肢夏科氏神经关节病相关；仅有极少文献报道过这种关联。本病例报告呈现了一例由CSM引起的肩部夏科氏关节病罕见病例。一名57岁女性因右肩部外伤就诊于急诊科。临床检查发现有压痛、广泛肿胀和瘀斑，活动范围受限，同时右臂和腿部麻木。通过影像学和实验室检查，诊断为CSM继发的CN。进行了反式全肩关节置换术，然而，术后两周出现了无创伤性的关节盂骨折和脱位并发症。随后进行了一期翻修手术，以促进骨折愈合，等待二期翻修手术。本报告深入探讨了肩部CN与CSM关联的极罕见可能性。文献综述表明，反式肩关节置换术是严重骨和软组织损伤病例的金标准。在对夏科氏神经关节病进行检查时，医生必须详细询问病史，同时进行详细的神经系统检查和颈椎成像，以免漏诊与CSM的关联。
