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Thread: Charcot Joint, Neuropathic shoulder

  1. #1

    Charcot Joint, Neuropathic shoulder

    My 32 year old son was born with spina bifida L5, shunted. At birth, he had sensation in his toes, patchy along calves, buttocks. When he was 4, he had his first decompression for Arnold/ Chiari syndrome, at 15 his spinal cord untethered (it has apparently tethered again.) At 22 he went into full respiratory arrest because his shunt was likened to an old straw with vertical breakage, not horizontal, and went unnoticed in a CAT scan he had received one month prior.

    Anyway, after the arrest, he was left with hand deficits mainly a weakened gri, balance problems, etc and spent 8 weeks in a pediatric rehab facility. Four years ago he could stand with AFO's. He was leaning on the bed as his aide helped him get dressed and he fell. Not a bad fall, said nothing hurt and went on his way. Two days later his shoulder started swelling a bit and was painful but two Advil took care of the pain.

    His nurse came for a regular visit and told me his shoulder was at the least dislocated and probably broken. I was shocked as he had not really felt any bad pain but I immediately took him to the ER. When the Xray was complete, the ER doctor told me his shoulder was shattered, crystallized, basically gone. I was told he had a Neurogenic shoulder, a nurse called it a Charcot shoulder, as it presented like Charcot Marie Tooth disease. Many doctors and second opinions later we were told he is not a good candidate for a shoulder replacement, has osteoporosis but none thought it caused this type of ground glass appearance on x rays and CT scans.

    After an electrical nerve test on his shoulder, the results appeared notmal but doctor felt he was "wired" a bit different than normal and that could be the reason for lack of pain and his shoulder dissolving. We were told that shoulders, knees and ankles if I remember correctly could be next but mercifully they have been OK. So I don't know if he was born with this wiring or if Arnold Chiari and or syringomyelia, or something else caused this problem. I have never read of anyone with spina bifida developing Charcot joints.

    I apologize for writing a novel. Best wishes to you.

  2. #2
    Charcot-Marie-Tooth is an inherited peripheral nerve condition that is not associated with spina bifida. It is a totally different condition from a Charcot joint (although both are named for a famous neurologist of the past).

    We do sometimes see Charcot joints, which is a deterioration of a joint below a spinal cord injury level. It often looks as if the joint surfaces have dissolved. These happen below the spinal cord injury level though, so unless your son's SB is very high (like in the neck) I would question a shoulder problem being due to this. If he had damage to the cervical cord with the surgery you describe, and had lack of sensation in his shoulder, then I supposed it could be considered a Charcot joint.

    Regardless, I would recommend that he see both a rehab physician and an orthopedic surgeon who specializes in shoulder surgery to see what can be done, if anything.

    (KLD)

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