Neuropathic Joint

Neuropathic Joint

July 10, 2010Musculoskeletal

39 years old female presented with Shoulder Swelling
Can you give DDx?

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?

Answers:

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 ).