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Sunday, July 25, 2010

Neuropathic Joint

Neuropathic Joint
July 10, 2010Musculoskeletal
39 years old female presented with Shoulder Swelling
Can you give DDx?

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Elbow joint (Left) in another patient with the same condition, and a T1 MRI (Right) of their neck. What is your final Dx & explanation of all findings?
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Answers:
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Neuropathic Joint – Acute:
  • Plain films showed nearly complete  resorption of the shoulder and elbow joint, with an almost “surgical like” margin.
  • Considerations include tumor & infection, but note essentially normal mineralization of the remaining bone. Also, involvement of both sides of the joint makes infection unlikely.
  • This represents the “acute” form of a neuropathic joint, and the MRI image shows syringohydromyelia (* note that 25% of patients with syringomyelia will develop a neuropathic joint).
  • Neuropathic Joint Pnemonic: “DS6” ( Diabetes, Syphilis, Steroids, Spinal Cord Injury, Spina Bifida, Syringomyelia, Scleroderma ).

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