Humeral head replacement for syringomyelia-associated Charcot shoulder arthropathy: a case report and literature review.

BACKGROUND: Syringomyelia combined with Charcot shoulder arthropathy is a highly disabling neuropathic joint disorder. The core pathology involves dual damage to pain/temperature sensation and sympathetic fibers due to the syrinx, leading the glenohumeral joint to endure abnormal mechanical stress without neural protection, resulting in bone and joint destruction. However, due to the rarity of the disease, its treatment is highly controversial. This paper reports a case of humeral head replacement for Charcot shoulder arthropathy caused by syringomyelia and reviews the relevant literature for reference.

CASE PRESENTATION: A 50-year-old female patient presented to our hospital with right shoulder pain and limited mobility for 6 years. Examination revealed syringomyelia combined with right shoulder Charcot arthropathy and right shoulder dislocation. We addressed the patient's joint pathology using humeral head replacement and rotator cuff repair; her syringomyelia and Chiari malformation were scheduled for secondary surgery. At the one-year postoperative follow-up, numbness on the dorsum of the right hand was significantly reduced, the range of motion of the right shoulder joint was markedly increased, and the shoulder Constant-Murley score was 80.

CONCLUSION: Performing joint replacement first for secondary Charcot arthropathy to alleviate pain and meet the patient's functional needs, followed by elective surgery for the primary neurological disease, may be more suitable for patients with syringomyelia combined with end-stage Charcot arthropathy. For such patients, multidisciplinary collaboration and long-term follow-up are essential to optimize surgical treatment strategies and improve long-term outcomes.