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Charcot's Arthropathy - Shoulder M14.61 713.5

 

synonyms: neuropathic shoulder, Charcot shoulder

Charcot Shoulder ICD-10

Charcot Shoulder ICD-9

  • 336.0 (other diseases of spinal cord, syringomyelia and syringbulbia
  • 713.5 (arthropathy associated with neurologic disorders
  • 716.81 (unspecified arthropathy, shoulder region)

Charcot Shoulder Etiology / Epidemiology / Natural History

  • Rare rapid destruction of the proximal humerus and glenoid related to neuropathic disease.
  • Associated with syringomyelia, alcholic neuropathy, syphilis and postoperative neuropathy.

Charcot Shoulder Anatomy

Charcot Shoulder Clinical Evaluation

  • Presents with swelling pain and stiffness.
  • May present with dislocated shoulder.
  • Generally decreased active and passive ROM.
  • Neurovascular exam indicated, often sensory and motor changes noted with asymmetric upper extremity reflexes.

Charcot Shoulder Xray / Diagnositc Tests

  • AP, scapular lateral and axillary views. Most common finding is resorption of the humeral head. May have glenoid resorption or shoulder dislocation. Look for pathologic fracture.
  • 4 Ds of Charcot's arthropathy: deformity, destruction, debris, and density. Radiographs may demonstrate bone fragmentation and radiodensity. 
  • MRI of cervical spinal should be considered for patients with upper extremity neuropathic joints to evaluate for cystic lesions or syrin.  Upper extremity neuropathic joints are frequently associated with syringomyelia.

Charcot Shoulder Classification / Treatment

  • Activity modification, rest, part-time immobilization in a sling
  • Joint Replacement contraindicated due to poor bone stock, high complication rate

Charcot Shoulder Associated Injuries / Differential Diagnosis

  • Osteomyelitis / Septic joint
  • Glenohumeral arthritis
  • Septic arthritis

Charcot Shoulder Complications

  •  

Charcot Shoulder Follow-up Care

  •  Simple observation

Charcot Shoulder Review References

  • Hatzis N, JBJS, 1998;80A:1314.