TY - JOUR
T1 - Septic elbow in the setting of neuropathic joint as the initial presentation of a cervical syrinx
AU - Strike, Sophia A.
AU - Johnston, James C.
AU - Farjoodi, Payam
PY - 2011/4
Y1 - 2011/4
N2 - Neuropathic arthropathy, or Charcot's joint, is a degenerative disorder resulting from abnormal sensory innervation that is associated with diabetes mellitus, tabes dorsalis, and syringomyelia. Patients may present with a painless instability of the affected joint, although a range of symptoms are seen. This article presents a case of a patient who presented with a swollen elbow, consistent with septic arthritis, and bilateral lower extremity weakness. Joint fluid cultures were positive for methicillin-resistant Staphylococcus aureus. Extensive joint destruction on radiographic imaging and a thorough neurologic examination revealing generalized weakness and upper motor neuron signs prompted magnetic resonance imaging (MRI) of the spine which revealed a cervical syrinx. Our patient was diagnosed with syringomyelia-associated neuropathic arthropathy that initially presented as a septic joint. In the setting of septic arthritis, substantial joint destruction (particularly in a patient with neurologic deficits) should prompt additional investigation, including MRI of the spine, for neurologic causes. Although surgery is generally not recommended for neuropathic arthropathy because of poor healing and high rates of complication, neuropathic arthropathy in the setting of a septic joint requires operative irrigation and debridement.
AB - Neuropathic arthropathy, or Charcot's joint, is a degenerative disorder resulting from abnormal sensory innervation that is associated with diabetes mellitus, tabes dorsalis, and syringomyelia. Patients may present with a painless instability of the affected joint, although a range of symptoms are seen. This article presents a case of a patient who presented with a swollen elbow, consistent with septic arthritis, and bilateral lower extremity weakness. Joint fluid cultures were positive for methicillin-resistant Staphylococcus aureus. Extensive joint destruction on radiographic imaging and a thorough neurologic examination revealing generalized weakness and upper motor neuron signs prompted magnetic resonance imaging (MRI) of the spine which revealed a cervical syrinx. Our patient was diagnosed with syringomyelia-associated neuropathic arthropathy that initially presented as a septic joint. In the setting of septic arthritis, substantial joint destruction (particularly in a patient with neurologic deficits) should prompt additional investigation, including MRI of the spine, for neurologic causes. Although surgery is generally not recommended for neuropathic arthropathy because of poor healing and high rates of complication, neuropathic arthropathy in the setting of a septic joint requires operative irrigation and debridement.
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U2 - 10.3928/01477447-20110228-22
DO - 10.3928/01477447-20110228-22
M3 - Article
C2 - 21469625
AN - SCOPUS:79955010806
SN - 0147-7447
VL - 34
JO - Orthopedics
JF - Orthopedics
IS - 4
ER -