Occurrence of neuropathic osteoarthropathy of the elbow joint after fixation of the radius nonunion in a patient with syringomyelia

Neuropathic arthropathy of the elbow treated with double-plate arthrodesis and resection site bone graft

Neuropathic arthropathy of the elbow is a rare condition, which is disabling and difficult to treat. Initial treatment is conservative and arthrodesis is rarely indicated. We describe an unusual case of progressive unilateral elbow swelling in a 37-year-old female domestic helper. She was found to have neuropathic arthropathy of her right elbow secondary to underlying cervico-thoracic syringomyelia. She underwent decompression of the syringomyelia before underdoing elbow fusion. Her elbow was initially immobilized in a cast to minimize bony fragmentation and soft tissue swelling. Serial X-rays were performed with a regular change of cast as the swelling subsided. When there was no further radiological evidence of bony fragmentation, elbow fusion at 60° was performed using a two-plate technique at 7 months after the initial presentation. With well-preserved ipsilateral hand function, she was could still perform household chores despite having a fused elbow. Radiological evidence of successful elbow fusion was documented at 23 weeks after surgery. There were no complications. If elbow fusion is considered, we recommend a trial of immobilization in the preferred angle of fusion to assess the patient's suitability. Factors such as the young age of a patient and good quality bone may also contribute to the success of the fusion.

Neuropathic elbow arthropathy: a review of six cases

Neuropathic arthropathy, also known as Charcot arthropathy, of the elbow joint is a rare and progressive joint disorder with little available information in the literature. Presentation and treatment data on 6 patients with this pathology are reviewed. In addition, outcome data are presented on all 6 patients at a mean follow-up of 51 months. Three of these patients had undergone surgical procedures for the treatment of their pathology. At the time of their latest follow-up, 2 patients had died but reported good pain relief and functional range of motion before their deaths. At a mean follow-up of 63 months, the remaining 4 patients also had minimal pain. Of these 4 patients, 3 reported moderate to gross instability in their elbows. Nevertheless, all 4 patients had good functional use of their arms with a mean Mayo Elbow Performance Score of 91. Our data suggest that surgical treatment of appropriate patients does not necessarily preclude a successful outcome. However, surgical treatment was also associated with an unpredictable course and a high rate of complications. Therefore, most patients with this pathology should be treated with nonoperative methods, and routine surgical intervention should be avoided.

Neuropathic arthropathy of the elbow. A report of five cases

BACKGROUND

Neuropathic arthropathy of the elbow is rare and characterized by a painless but unstable articulation. The functional capacity of patients with this condition has not been reviewed in detail.

METHODS

Five male patients, with an average age of fifty-one years, were treated for neuropathic arthropathy of the elbow. The underlying conditions associated with the arthropathy included syringomyelia, insulin-dependent diabetes mellitus, end-stage renal failure, and two cases of polyneuropathy of unknown cause. Four patients sought medical attention after a specific traumatic event. Peripheral sensory and motor dysfunction was present in each patient. Radiographs of the elbow revealed dislocation, fracture fragmentation, and heterotopic ossification. Our management of the neuropathic elbows centered on maintenance of a functional arc of motion through physical therapy aimed at regaining muscle strength and the use of orthoses for support. Operative treatment was performed for an associated ulnar or radial nerve compression syndrome in three patients, and an open reduction and internal fixation of an unstable proximal ulnar nonunion associated with loose implants was performed in one.

RESULTS

The patients were followed for an average of nineteen months, with a range of twelve to thirty-six months. All patients had a pain-free elbow with a functional range of motion at the most recent follow-up examination, and none wished to have further treatment. The operatively treated ulnar nonunion united successfully. All three patients treated surgically for an associated nerve compression syndrome had recovery of nerve function.

CONCLUSION

In the face of instability and gross distortion of the joint, the patients in this series demonstrated remarkably good function.