J Korean Orthop Assoc.  2008 Dec;43(6):677-684.

Neuropathic Arthropathy of the Elbow

• Kim JY
• Chung MS
• Lee YH
• Rhee SH
• Gong HS
• Suh ES
• Baek GH

Abstract

PURPOSE: Neuropathic arthropathy of the elbow is extremely rare and is characterized by painless destruction of the joint due to diminished proprioception. We report five cases of neuropathic arthropathy of the elbow with review of pertinent literature.
MATERIALS AND METHODS
We analyzed records of five patients who were diagnosed with neuropathic arthropathy of the elbow. There were three men and two women with a mean age of 38.6 years (range, thirteen to fifty years). The conditions associated with the arthropathy were three cases of syringomyelia, one tabes dorsalis, and one neurofibromatosis. One patient was conservatively treated and was followed periodically and others underwent operative procedures. The mean duration of follow-up was 8.5 years (range, one to nineteen years). Changes of symptoms, range of motion (ROM), and functional satisfaction were assessed.
RESULTS
The conservatively treated patient maintained the function of the elbow. In the surgically treated group, one case of ulnar nerve decompression and one case of osteosynthesis of the fractured olecranon showed improvement of symptoms, ROM, and function. But two patients who underwent reconstructive procedures had decreased ROM after complication of deep infection. Concluson: Neuropathic arthropathy of the elbow causes few functional problems despite of the radiologic destruction and instability of the elbow. Therefore symptomatic management is considered more preferable than surgical correction of destruction or instability of the elbow.

Keyword

Elbow; Neuropathic arthropathy; Syringomyelia

MeSH Terms

Decompression
Elbow
Female
Follow-Up Studies
Humans
Joints
Male
Neurofibromatoses
Olecranon Process
Proprioception
Range of Motion, Articular
Surgical Procedures, Operative
Syringomyelia
Tabes Dorsalis
Ulnar Nerve

Figure

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  Fig. 1 Case 1. Plain roentgenograms reveal heterotopic ossification, small bony fragments, and diffuse subchondral sclerosis around the elbow joint (A and B).

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  Fig. 2 Case 3. Initial roentgenogram reveals the substantial absorption of medial humeral condyle (A). Resection arthroplasty was done for the control of infection after resection of fibroma, and it shows dislocation of the radial head (B). For the reduction of radial head, shortening osteotomy of radial shaft and annular ligament reconstruction were performed (C). At final follow-up, he complained of limitation in range of motion (D).

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  Fig. 3 Case 5. Plain roentgenogram reveals fracture of olecranon, diffuse small bony fragments, and ossified fragments (A). Open reduction and internal fixation was done. On postoperative 1 year, union of fracture site of olecranon was progressed, whereas radial head and both humeral condyle were resorpted increasingly (B). But she did not complain any discomfort for the function of her elbow (C and D).

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