Neuroarthropathy of the Wrist in Paraplegia: A Case Report

Abstract

Background/Objective: Neuroarthropathy, also known as Charcot joint, is most commonly seen in the spine and other weight-bearing joints in individuals with spinal cord injury (SCI). It is rarely seen in the joints of the upper extremities because the pathophysiology of the neuroarthropathy is thought to be significant repetitive trauma such as with weight bearing in an insensate joint.Methods: Case report of neuroarthropathy in the wrist of a 46-year-old man with a 30-year history of T4 paraplegia caused by ependymoma. Results:The patient recently developed a nonpainful swelling in the left wrist, which had decreased sensation since the time of his initial SCI. Radiological evaluation showed marked degenerative changes consistent with neuroarthropathy. A magnetic resonance image of the spine showed spinal cord atrophy at the cervicothoracic junction.Conclusions: This case shows an unusual presentation of a neuroarthropathy in a wrist in an individual with functional paraplegia. Because the treatment options for neuroarthropathy in the upper extremity in individuals with SCI are limited, early diagnosis is crucial to implement conservative management before significant destruction of the joint occurs.

Rapid Spontaneous Total Fusion of Neuropathic Arthropathy of the Wrist After Limited Intercarpal Arthrodesis: A Case Report and Brief Literature Review

“…We performed a literature search for abstracts of articles describing patients’ symptoms and obtained information from 16 cases of NA of the wrist ( Table 1 ). According to the descriptions of the patients in previous literature, we found the majority of patients ( 1 , 5 , 6 , 15 – 21 ) admitted to the hospital had developed to stage 2: soft tissue swelling, bone resorption, subluxations, fractures, and extra-articular bone fragments. The patient we report here should also have been in stage 2 at the time of initial admission to our department.…”

“…Carpal NA may be misdiagnosed as osteoarthritis ( 16 ), carpal tunnel syndrome ( 15 ), complex regional pain syndrome ( 5 ), gout ( 17 ), and acute inflammatory disease ( 17 ). Compared with these diseases, the main differences of NA of the wrist lie in carpal abnormalities and the decrease of sensation in the affected area, including superficial and deep sensation, may occur earlier than joint changes, but the symptoms are not specific ( 5 , 15 ). Though the NA wrist is usually painless, some cases of pain have been reported ( 5 , 24 ).…”

Neuroarthropathy of the hip following spinal cord injury

“…They implicated surgical laminectomy and the ensuing instability as a possible cause of neuropathic psuedarthrosis in four of the five cases and advocated repeat surgical stabilization and fusion for improved outcomes. Shem reported on a 46-year-old man with a 30-year history of T4 paraplegia secondary to an ependymoma who gradually developed painless swelling and arthropathy of his left wrist that was managed conservatively with bracing 4. The author indicated that such an occurrence in the setting of SCI can compromise wheelchair use and performance of activities of daily living independently.…”

“…Shem reported on a 46-year-old man with a 30-year history of T4 paraplegia secondary to an ependymoma who gradually developed painless swelling and arthropathy of his left wrist that was managed conservatively with bracing. 4 The author indicated that such an occurrence in the setting of SCI can compromise wheelchair use and performance of activities of daily living independently.…”

Charcot Neuroarthropathy of the Foot and Ankle

“…C harcot neuroarthropathy (CN) is a progressive, deforming disease of the bone and joints, especially affecting the foot and ankle. However, it can affect other joints such as the wrist, knee, spine and shoulder [1][2][3][4] . Although it is rare, it leads to considerable morbidity.…”