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NEUROIMAGES
Year : 2016  |  Volume : 64  |  Issue : 5  |  Page : 1099-1100

Bilateral ulnar neuropathy at the elbow secondary to Charcot-joint associated with Chiari malformation and syringomyelia


Department of Neurosurgery, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India

Date of Web Publication12-Sep-2016

Correspondence Address:
Venkata R.C. Vemula
Department of Neurosurgery, Sri Venkateswara Institute of Medical Sciences, Tirupati - 517 507, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.190297

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How to cite this article:
Vemula VR, Bodapati CP, Vuttarkar J, Vosuri BB. Bilateral ulnar neuropathy at the elbow secondary to Charcot-joint associated with Chiari malformation and syringomyelia. Neurol India 2016;64:1099-100

How to cite this URL:
Vemula VR, Bodapati CP, Vuttarkar J, Vosuri BB. Bilateral ulnar neuropathy at the elbow secondary to Charcot-joint associated with Chiari malformation and syringomyelia. Neurol India [serial online] 2016 [cited 2019 Sep 18];64:1099-100. Available from: http://www.neurologyindia.com/text.asp?2016/64/5/1099/190297




Neuropathic joints (Charcot joints) are a chronic form of degenerative arthropathy caused by a loss of sensation in the joints so that the joints are severely damaged and disrupted.[1] There are two theories describing the pathogenesis of neuropathic arthropathy (NA), the more popular Neurotraumatic theory, and a lesser known, Neurovascular theory.[2] NA is most commonly caused by chronic neurologic illnesses such as syringomyelia, diabetes mellitus, and tabes dorsalis.[2] Other rare disorders associated with NA are leprosy, amyloidosis, peripheral nerve injury, myelomeningocele, spinal cord injury, familial dysautonomia, and congenital insensitivity to pain.[3] In syringomyelia, neuropathic changes are relatively more common at the shoulder joint, followed by the elbow and wrist.[4] There are very few cases reported in the literature of NA involving the elbow joint secondary to syringomyelia. NA of the elbow joint causing ulnar nerve palsy is even rarer.[5],[6],[7] We report a case of  Chiari malformation More Details with syringomyelia presenting with bilateral ulnar nerve palsy secondary to NA involving both the elbow joints.

A 55-year-old gentleman presented with a 4-year history of painless swellings of bilateral elbows (left more than the right), and a 6-month history of weakness, deformity of both hands, and sensory loss over his forearms and hands. Local examination revealed a boggy, nontender swelling of both the elbows (left more than the right) [Figure 1]a with crepitus and loose bodies. Neurological examination revealed reduced sensation to touch, pain, and temperature over the C5 to T1 dermatome, bilateral claw hands [Figure 1]b and weakness of hand grip secondary to bilateral ulnar nerve palsy. Radiological examination of the elbow joint [Figure 1]c was consistent with NA. The magnetic resonance imaging of the cervical spine [Figure 1]d] revealed Chiari malformation with syringomyelia. The patient underwent foramen magnum decompression with duraplasty.
Figure 1: (a) Clinical photograph of the patient showing swelling of the left elbow joint. (b) Clinical photograph of the left hand of the patient showing ulnar clawing. (c) Radiology of the left elbow joint revealing destructive changes with loss of bone and joint architecture. (d) T2-weighted sagittal magnetic resonance imaging of the cervical spine revealing Chiari malformation with syringomyelia

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  References Top

1.
Johnson JT. Neuropathic fractures and joint injuries. Pathogenesis and rationale of prevention and treatment. J Bone Joint Surg Am 1967;49:1-30.  Back to cited text no. 1
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2.
Allman RM, Brower AC, Kotlyarov EB. Neuropathic bone and joint disease. Radiol Clin North Am 1988;26:1373-81.  Back to cited text no. 2
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3.
Shapiro G, Bostrom M. Heterotopic ossification and Charcot neuroarthropathy. In: Chapman MW, editors. Chapman's Orthopaedic Surgery. Philadelphia, Pa, USA: Lippincott Williams & Wilkins; 2001. p. 3245-62.  Back to cited text no. 3
    
4.
Deng X, Wu L, Yang C, Xu Y. Neuropathic arthropathy caused by syringomyelia. J Neurosurg Spine 2013;18:303-9.  Back to cited text no. 4
[PUBMED]    
5.
Nozawa S, Miyamoto K, Nishimoto H, Sakaguchi Y, Hosoe H, Shimizu K. Charcot joint in the elbow associated with syringomyelia. Orthopedics 2003;26:731-2.  Back to cited text no. 5
[PUBMED]    
6.
Ruette P, Stuyck J, Debeer P. Neuropathic arthropathy of the shoulder and elbow associated with syringomyelia: A report of 3 cases. Acta Orthop Belg 2007;73:525-9.  Back to cited text no. 6
[PUBMED]    
7.
Sahoo SK, Salunke P. Charcot arthropathy of the elbow joint as a presenting feature of Chiari malformation with syringomyelia. Br J Neurosurg 2014;28:811-2.  Back to cited text no. 7
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