Charcot shoulder and elbow: a review of the literature and update on treatment

Charcot arthropathy of the shoulder and elbow is a rare disease process initially described in the 1700s; however, it was not until the 19th century that physicians understood its association with other disease processes such as cervical spine pathology and diabetes. A primary complaint is painful or painless joint dysfunction, meaning the orthopedic surgeon is regularly the first physician to evaluate the patient. Frequently, the condition of these patients is misdiagnosed. Although the pathogenesis of the disease is controversial, the etiology is commonly due to syringomyelia. The key to successful management is a thorough history and examination along with a workup including specific laboratory testing and imaging to rule out other disease processes. Most neuropathic shoulders and elbows have historically been managed conservatively because of poor outcomes with operative interventions. Newer data have emerged hinting that early neurosurgical intervention can stabilize this degenerative process. If clinical and radiographic stabilization occurs, recent studies have outlined surgical indications that can provide surgeons with a guide as to patients in whom successful operative outcomes can be achieved in the face of failed conservative management.