Charcot Neuroarthropathy of the Shoulder Caused by Cervical Spondylotic Myelopathy: A Case Report and Literature Review

Abstract

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.

Keywords: cervical spondylotic myelopathy (csm); charcot neuroarthopathy; charcot's joint; reverse shoulder arthoplasty; syringomyelia.

Figure 1. Pre-operative radiographs

a. AP b. PA radiograph of the right shoulder depicting degenerative changes to the humeral head consistent with Charcot arthropathy (white arrows).

Figure 2. A 3D reconstruction scan showing destructive changes correlating with Charcot neuroarthropathy

a. anterior view b. lateral view showing humeral head changes (white arrows).

Figure 3. Magnetic Resonance Imaging radiographs prior to surgery

a. Coronal b. Sagittal MRI view of the shoulder showing destruction of the shoulder joint (white arrows).

Figure 4. Magnetic resonance imaging of the spine

a. T2 sagittal MRI of the spine showing cervical stenosis at the level of C3-4 (shown in white arrow). There is also evidence of lower-level impingement in the thoracic spine. b. Axial MRI of the spine with the “snake eye sign” shows extensive destruction and long-standing chronic changes in the spinal cord (white arrow).

Figure 5. Radiograph of shoulder post-reverse total shoulder arthroplasties (TSA) a. AP of the prosthesis b. PA of the prosthesis

The shoulder x-ray shows the dislocation of the reverse arthroplasty

Figure 6. PRISMA flowchart showing the selection criteria