Bilateral Charcot’s arthropathy of shoulder secondary to syringomyelia –a rare case report

Abstract

Neuropathic arthropathy of the shoulder is a rare disorder that has been described in fewer thansixty patients in the world literature 1,3,4,7,10,12,14,17,18,20,27 I. Case ReportA 66-year-old male presented to our outpatient department with painless swelling of both his shoulders and restricted movements of the bilateral shoulder joints. His condition began when he was approximately 55 years old and he started experiencing reduced sensation in the bilateral upper limbs. Gradually he started experiencing reduced sensations in the bilateral lower limbs. Despite that, he did not seek medical attention and his condition gradually worsened. There was no history of significant trauma in the past.Physical examination revealed generalized swelling about the shoulder, more on the right side [ Figure 1]. On the right side, there was abnormal motion, where the shoulder joint would be expected, with huge abnormal swelling. On the other hand, the left shoulder joint was found to be dislocated, with humeral head anterior to glenoid cavity, leading to significant restricted joint movement. On palpation, the shoulder joints were nontender. Bilateral shoulder movements were restricted. Active forward flexion was 80° on the right and 30° on the left side, abduction 20° on the left and 25° on the right side and internal rotation bilaterally up to the sacrum. He had 4/5 shoulder abductor strength and 4/5 shoulder flexor and extensor strength bilaterally. Range of motion for passive movements was significantly higher than on active movements, more on the right side. Passive movement was painful on terminal range of motions. His biceps strength was 4/5; triceps strength was 5/5 while motor strength in bilateral distal extremities was 5/5. There was decreased sensation involving the entire upper extremities bilaterally. The biceps, triceps and brachioradialis reflex were absent.