GLENOHUMERAL NEUROARTHROPATHY ASSOCIATED WITH SYRINGOMYELIA: FOUR CASES

Introduction and purpose: Neuropathy associated with syringomyelia is a relatively rare entity that predominantly affects the glenohumeral joint. It is characterized by joint destruction, which is in many cases severe and which requires a differential diagnosis from other severe conditions. The therapeutic options are based on maintaining function rather than on immobilization. We present our experience of treating this condition in 4 cases. Materials and methods: The cases were 4 females with a mean age of 53.25 years. One of the cases had both the glenohumeral and carpal joints affected. Only in one case was there a known history of syrinogomyelia associated with Arnold Chari disease, whereas in the other 3 the diagnosis of syringomyelia was established by studying the neuroarthropathy. Results: Two of the patients were treated by means of joint replacement (one total and the other partial) with a favorable postoperative evolution in the medium term. Acceptable pain control and joint balance were achieved. At the end of 5 and 2 years respectively, the total and partial prosthesis had to be revised due to aseptic loosening of the components and joint instability, respectively. The conservative treatment applied to the two remaining cases achieved a functional range of movement for activities of daily living and one of the cases was able to continue with their usual work activities. Conclusions: In spite of numerous sources in the literature that advise against joint replacement, there are very few documented cases and series that substantiate that recommendation. In the long run, in our experience joint replacement is not a satisfactory treatment for glenohumeral neuroarthropathy.