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Charcot shoulder

Case contributed by Domenico Nicoletti
Diagnosis almost certain

Presentation

Elderly patient with decompensated insulin-dependent diabetes. Previous amputation of the left foot for diabetic vasculopathy. Physical examination revealed diffuse swelling about the right shoulder. On palpation, there was no joint tenderness or local rise of temperature. There was increased girth and exaggerated passive movements possible at the right shoulder joint in all directions. There was generalized muscle wasting in the right upper limb.

Patient Data

Age: 70 years
Gender: Female

Shoulder joint

mri

The articular surface of the humeral head is deformed and flattened in its upper outer portion, with modest marrow edema. It is associated with erosive alterations of the distal diaphysis of the clavicle and acromion.

There is abundant articular effusion with modest thickening of the synovium, and an irregular mass formation.

There is complete lesion of the supraspinatus tendon and the CLB tendon.

Case Discussion

Charcot shoulder is a chronic, degenerative arthropathy and is associated with decreased sensory innervation. Diabetes mellitus, syringomyelia and syphilis are the most common etiologies of this disease.

The differential diagnoses to be considered are septic arthritis, tuberculous and microbial infection, primary and metastatic malignant tumor of the bone or soft tissue and synovial chondromatosis.

Case Courtesy Dr. Sandra Pennacchini

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