Neuropathic arthropathy of the shoulder joint secondary to a syringomyelia.
Neuropathic arthropathy of the shoulder joint secondary to a syringomyelia.
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DOI：
10.1136/bcr-2018-228228
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发表时间：
2018-12-03
期刊：
影响因子：
0.9
通讯作者：
Pai, Vishal
中科院分区：
文献类型：
--
作者：
Nambiar, Mithun;Onggo, James Randolph;Pai, Vishal
一位29岁男性砌砖工人，有5个月的非创伤性右前外侧肩关节疼痛和肿胀病史。疼痛出现在晚上和休息时，但并不妨碍他工作。他没有明显的病史。他是一个吸烟者和非糖尿病患者。检查时，他的右肩肿胀，有轻微的烦躁，但外展范围有限。他的神经系统检查显示，上肢和下肢的张力、力量、本体感觉、感觉和反射正常。X线片显示肱骨近端和关节盂出现侵蚀性溶解（图1）。MRI证实双侧关节破坏性病变，有一个大而厚壁的充满液体的空腔（图2）。进行核医学扫描以进一步评估溶解性病变是孤立的还是广泛的。局部高度活动提示孤立性右肩关节病。血液检查显示C反应蛋白< 2（正常< 5），白细胞计数为8.5（正常4-10）。梅毒筛查、B12、叶酸、HBA 1c和血清电泳均正常。关节液的细针抽吸物显示无恶性肿瘤细胞，无晶体，微生物培养阴性。进一步的全脊柱MRI显示从C2-T10延伸的广泛的脊髓膨出（图3），小脑基底疝符合1型基亚里畸形。神经性（Charcot）关节病是继发于关节神经支配丧失的罕见退行性过程，其原因包括糖尿病、基亚里畸形、终末期肾病、脊髓痨、麻风病、创伤性脊髓损伤和多发性硬化症。肩神经性关节病
A 29-year-old male brick-layer presented with a 5-month history of atraumatic right anterolateral shoulder pain and swelling. Pain was present at night and rest but did not prevent him from working. He had no significant medical history. He was a smoker and non-diabetic. On examination, his right shoulder was swollen with minimal irritability but a limited abduction range. His neurological examination showed normal tone, power, proprioception, sensation and reflexes of the upper and lower limbs. X-ray showed an aggressive, lytic appearance of the proximal humerus and glenoid (figure 1). MRI confirmed a destructive lesion involving both sides of the joint with a large, thick walled fluid filled cavity (figure 2).A nuclear medicine scan was performed to further assess whether the lytic lesion was isolated or widespread. Localised high activity suggested an isolated right shoulder arthropathy. Blood test investigations demonstrated C reactive protein< 2 (normal< 5) and a white-cell count of 8.5 (normal 4–10). A syphilis screen, B12, folate, HBA1c and serum electrophoresis were normal. A fine needle aspirate of joint fluid demonstrated no malignant tumour cells, no crystals and a negative culture for organisms. Further MRI of the whole spine revealed an extensive syringomyelia extending from C2-T10 (figure 3), with a basilar herniation of the cerebellum consistent with a type 1 Chiari malformation. Neuropathic (Charcot) arthropathy is a rare degenerative process secondary to a loss of innervation to a joint, causes of which include diabetes, Chiari malformation, end stage renal disease, tabes dorsalis, leprosy, traumatic spinal cord injury and multiple sclerosis. Shoulder neuropathic arthropathy