Humeral Head Arthroplasty for Charcot Shoulder Arthropathy Secondary to Syringomyelia

Overview

This case study reports successful humeral head replacement (HHR) combined with rotator cuff repair in a 50-year-old female with Charcot shoulder arthropathy secondary to syringomyelia. One year postoperatively, the patient showed significant pain relief, improved shoulder range of motion, and a Constant–Murley score of 80, highlighting the potential of staged surgical management.

Background

Syringomyelia is a progressive neurological disorder characterized by cystic cavitation within the spinal cord, leading to loss of pain and temperature sensation and sympathetic dysfunction. This results in neuropathic arthropathy, commonly affecting the shoulder joint, causing rapid joint destruction and instability. Due to the rarity of Charcot shoulder secondary to syringomyelia (CSSS), treatment remains controversial with limited evidence. Traditional conservative and arthrodesis treatments have limitations, while total or reverse shoulder arthroplasty carries high complication risks. Humeral head replacement offers a theoretically safer alternative but lacks extensive clinical data.

Data Highlights

Preoperative shoulder range of motion: forward flexion 90°, extension 20°, abduction 90°, adduction 20°, internal/external rotation 10°.
Postoperative shoulder Constant–Murley score at 1 year: 80.
MRI showed syringomyelia from C2-T5 with 7 mm maximum width and 8 mm cerebellar tonsillar herniation.
Imaging revealed osteolytic bone destruction, right shoulder dislocation, and large humeral head defect.

Key Findings

• The patient presented with 6 years of right shoulder pain, limited mobility, and sensory deficits consistent with syringomyelia affecting C6–C7 dermatomes.
• Imaging confirmed syringomyelia with Chiari malformation type I and severe neuropathic destruction of the right shoulder joint.
• Humeral head replacement combined with rotator cuff repair was performed as the initial surgical intervention.
• At one-year follow-up, the patient had marked improvement in shoulder function and reduced numbness.
• Staged surgical management addressing joint pathology first, followed by neurological correction, may optimize outcomes in CSSS.
• Multidisciplinary collaboration and long-term follow-up are critical for managing this complex condition.

Clinical Implications

For patients with syringomyelia-induced Charcot shoulder arthropathy, early joint replacement focusing on pain relief and functional restoration can be beneficial before addressing the primary neurological disorder. Humeral head replacement may reduce complications compared to total shoulder arthroplasty in this population. Coordinated multidisciplinary care and vigilant long-term monitoring are essential to improve surgical success and patient quality of life.

Conclusion

Humeral head arthroplasty combined with rotator cuff repair offers a promising surgical option for end-stage Charcot shoulder arthropathy secondary to syringomyelia. A staged approach prioritizing joint reconstruction followed by neurological intervention, supported by multidisciplinary collaboration, may enhance functional outcomes and reduce complications.

References

1. Case Study and Literature Review, 2024 -- Humeral Head Arthroplasty in Charcot Shoulder Arthropathy Secondary to Syringomyelia