Hemiarthroplasty for charcot shoulder arthropathy secondary to syringomyelia: a case report and literature review

Hemiarthroplasty for charcot shoulder arthropathy secondary to syringomyelia: a case report and literature review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Hemiarthroplasty for charcot shoulder arthropathy secondary to syringomyelia: a case report and literature review Lin Zhang, Jinglin Li, Fuyin Yang, Jiaze Peng, Yang Yu, Xianpeng Huang, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7521645/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Syringomyelia complicated by Charcot shoulder arthropathy is a severely debilitating neuropathic joint disorder. The core pathology involves dual impairment of pain-temperature sensation and sympathetic fibers due to the syrinx, leading the glenohumeral joint to endure abnormal mechanical stress without neuroprotective feedback, resulting in progressive osseous and articular destruction. However, due to the rarity of this condition, its management remains highly controversial. This article reports a case of hemiarthroplasty for Charcot shoulder arthropathy caused by syringomyelia and reviews the relevant literature for reference. Case Presentation A 50-year-old female patient presented to our hospital with a 6-year history of right shoulder pain and restricted mobility. Examinations confirmed syringomyelia with concomitant right-sided Charcot shoulder arthropathy and glenohumeral dislocation. The patient underwent hemiarthroplasty of the humeral head combined with rotator cuff repair to address the joint pathology. The management of the syringomyelia and associated Chiari malformation was planned for a second-stage surgery. At the one-month postoperative follow-up, numbness on the dorsum of the right hand had significantly decreased, the range of motion (ROM) of the right shoulder had markedly improved, and the shoulder Constant-Murley score was 80. Conclusion Prioritizing joint arthroplasty to address secondary Charcot arthropathy for pain relief and functional improvement, followed by elective surgery for the primary neurological disorder, may be a more suitable strategy for patients with syringomyelia and end-stage Charcot shoulder arthropathy. Multidisciplinary collaboration and long-term follow-up are essential for optimizing surgical strategies and improving long-term outcomes in these patients. Syringomyelia Charcot shoulder arthropathy hemiarthroplasty Case report Figures Figure 1 Figure 2 Figure 3 Background Syringomyelia is a chronic, progressive neurological disorder characterized by cystic cavitation within the spinal cord. This lesion disrupts pain-temperature sensation and sympathetic fibers within the cord, leading to impaired protective sensation in the corresponding dermatomes and neurotrophic imbalance, which can subsequently induce neuropathic arthropathy [ 1 ] . The shoulder joint is one of the most commonly affected sites, manifesting as recurrent occult trauma, rapidly progressive osteolysis, joint collapse, and instability, ultimately resulting in complete joint destruction and severe functional impairment [ 1 ] . Due to the extreme rarity of Charcot shoulder secondary to syringomyelia (CSSS), there is a lack of evidence-based medical evidence and consensus guidelines, posing significant challenges in clinical decision-making. Traditional conservative treatments are of uncertain efficacy in halting joint destruction, while arthrodesis has gradually fallen out of favor due to substantial loss of function. Although total shoulder arthroplasty or reverse shoulder arthroplasty can restore some degree of mobility, neuropathic bone defects, rotator cuff and ligament insufficiency, and persistent abnormal stress significantly increase the risks of prosthetic loosening, infection, and periprosthetic fracture, leading to a high postoperative failure rate [ 2 , 3 ] . Hemiarthroplasty, which preserves glenoid bone stock and involves relatively simplified procedures, is theoretically considered to potentially reduce complication rates. However, its feasibility, surgical techniques, and early functional outcomes in CSSS have only been sporadically reported in individual cases. Furthermore, patients with CSSS often initially present with joint symptoms, leading to delayed diagnosis and treatment of the primary neurological disorder, resulting in irreversible neurological damage and joint destruction. Therefore, defining surgical strategies for end-stage CSSS, optimizing multidisciplinary collaboration pathways, and evaluating long-term efficacy are of urgent clinical significance for improving patient outcomes. This study reports a case of CSSS managed by a multidisciplinary team (MDT), involving initial hemiarthroplasty combined with rotator cuff repair to reconstruct glenohumeral joint function, with planned second-stage management of the Chiari malformation and syringomyelia. A review of relevant literature is also provided to offer insights into the treatment of CSSS. Case Presentation Preoperative Presentation A 50-year-old right-handed female patient presented with a 6-year history of dull pain and progressively worsening restricted mobility in her right shoulder, affecting activities such as hair combing and dressing. Subsequently, she developed numbness over the dorsum of the right hand in the region of the 1st to 3rd metacarpals. She had no history of diabetes or trauma. Physical examination revealed right shoulder active range of motion: forward flexion 60°, abduction 45°, extension 20°, and external rotation 10°. Hypoalgesia was noted on the dorsum of the right hand. Laboratory findings: CRP and ESR were normal; Glycated hemoglobin (HbA1c) was 5.2%. Cervical spine MRI revealed a syrinx extending from C2 to T5, with a maximum width of 7 mm, and cerebellar tonsillar descent (Chiari I malformation) of 8 mm. Right shoulder X-ray and CT showed osteolytic bone destruction of the articular components and dislocation of the right glenohumeral joint. MRI of the right shoulder demonstrated loss of the glenoid structure, a large defect in the humeral head, a large joint effusion, and extensive edema in the periarticular soft tissues. Diagnosis: 1. Syringomyelia with Chiari Malformation Type I; 2. Right Charcot Shoulder Arthropathy; 3. Right Shoulder Dislocation. Surgical Management Following multidisciplinary discussion, right shoulder hemiarthroplasty was performed first. Under general anesthesia, the patient was placed in the beach-chair position. After standard sterilization and draping, a deltopectoral approach approximately 10 cm long, starting at the coracoid process, was utilized. Electrocautery was used to incise the skin, subcutaneous tissue, and superficial fascia sequentially. The interval between the deltoid and pectoralis major was developed, retracting a small portion of muscle fibers and the cephalic vein medially to expose the rotator cuff, joint capsule, and the insertion of the pectoralis major tendon. Intraoperative examination revealed a ruptured and retracted long head of the biceps tendon, which was tagged. The joint capsule was incised, and the subscapularis tendon was reflected anteriorly along with the capsule. Exploration showed near-complete dissolution of the greater tuberosity, a residual portion of the lesser tuberosity, and extensive dissolution of the anterior and inferior half of the humeral head, with partial loss of posterior cartilage and subchondral bone. After orientation, the remaining humeral head was resected using a precision bone saw system. The proximal humeral medullary canal was reamed. A size 2 trial stem was inserted, referencing the bicipital groove, and the height was determined based on the pectoralis major tendon insertion. Granulation tissue and bone fragments within the joint were debrided. A Lima SMR size 50 CTA humeral head trial was placed, demonstrating satisfactory fit and stability, confirmed by intraoperative fluoroscopy. The corresponding definitive prosthesis was implanted. Shoulder mobility was checked in all directions and found to be satisfactory without instability. The subscapularis tendon was repaired and sutured near the original footprint of the greater tuberosity using sutures. The long head of the biceps tendon was tenodesed locally. Shoulder range of motion was reassessed and remained satisfactory. The surgery concluded. The Chiari malformation and syringomyelia were indicated for surgery, planned as an elective suboccipital decompression at a later date. Postoperative Outcome At the one-month postoperative follow-up, numbness on the dorsum of the right hand had significantly decreased. The range of motion of the right shoulder had markedly improved in all directions. The shoulder Constant-Murley score was 80. Discussion Charcot shoulder arthropathy is a condition that occurs in patients with neurological disorders, progresses slowly, and causes joint damage that affects activities of daily living. One of its primary causes is syringomyelia in the cervical region [ 4 ] . Syringomyelia complicated by Charcot shoulder arthropathy (CSSS) is a rare and highly debilitating neuropathic joint disorder. Its core pathology involves dual impairment of pain-temperature sensation and sympathetic fibers due to the syrinx, causing the glenohumeral joint to endure abnormal mechanical stress without neuroprotective feedback, ultimately leading to bony fragmentation and joint dislocation [ 5 ] . The 50-year-old female patient in this case, with a 6-year history of right shoulder pain and dysfunction, imaging showing significant humeral head dissolution and glenohumeral dislocation, accompanied by a C2-T5 syrinx and Chiari Malformation Type I, represents a typical presentation of CSSS. The goals of treatment for patients with neuropathic arthropathy are early diagnosis, preservation of joint and limb function, and management of the underlying disease. However, there are currently no consensus guidelines in the literature regarding the treatment of syringomyelia-associated neuropathic arthropathy. Treatment modalities range from conservative approaches such as rehabilitation, joint protection strategies, patient education, and analgesics, to surgical interventions including arthrodesis, prosthetic arthroplasty, and neurosurgical procedures [ 6 , 7 ] . Management of CSSS must address both the primary neurological disease and the secondary joint pathology. Although conservative methods are often the initial treatment choice, the low prevalence of Charcot shoulder and the lack of long-term follow-up data make it difficult to ascertain the effectiveness of non-surgical therapy alone for Charcot shoulder [ 4 ] . According to the literature, surgical intervention is considered a reasonable treatment option for reducing pain and improving functional status in patients with CSSS. These interventions may be pursued after conservative management fails. For selected patients, surgical treatment may be considered as a primary option. For the primary disease, the main goal of intervention is to prevent further expansion of the syrinx and avoid damage to the remaining spinal cord. Existing data suggest that early treatment of the primary neurological disease may halt the progression of Charcot arthropathy. Grahovac et al. [ 8 ] reported a case of Charcot shoulder caused by Chiari I malformation with syringomyelia where, at 6-year follow-up after craniocervical decompression, there was no significant progression of the syrinx or joint pathology. Deng et al. [ 9 ] studied 12 patients with Charcot arthropathy caused by syringomyelia and found that 5 patients who underwent neurosurgical treatment for the primary disease showed improvement in neurological dysfunction postoperatively, without worsening of related joint symptoms. Among the 7 patients who did not undergo surgery, 5 experienced progression of joint destruction and neurological deterioration. Makihara et al. [ 10 ] reviewed a patient with Charcot shoulder who underwent suboccipital decompression for syringomyelia, showing improved proximal muscle strength, reduced sensory changes, and over time, bone regeneration resembling a new joint surface. Atalar et al. [ 11 ] reviewed 5 patients with syringomyelia and neuropathic shoulder arthropathy. Four patients underwent neurosurgical decompression and conservative treatment for the neuropathic joint, while one did not undergo syrinx decompression. All patients who received neurosurgical decompression showed improvements in the range of motion and function of the neuropathic joint. However, for patients who have developed end-stage structural destruction, decompression alone is often insufficient to restore joint function, and joint reconstruction still relies on arthroplasty. Many patients often present with joint symptoms preceding neurological symptoms. Once Charcot arthropathy is observed, the disease is often at an advanced stage, making treatment challenging [ 12 ] . In this case, while the Chiari malformation and syringomyelia had clear indications for neurosurgery, the MDT decided to perform hemiarthroplasty first, followed by second-stage craniocervical decompression, primarily based on: 1) The joint was dislocated with massive bone defects, and delayed reconstruction would further increase bone loss in the glenoid and proximal humerus; 2) Neurological symptom progression was relatively slow (only numbness on the hand dorsum), suggesting a controllable risk of syrinx expansion in the short term; 3) Stabilizing the shoulder joint first could provide a tolerable basis for early postoperative rehabilitation following the second-stage suboccipital decompression. This "reverse sequential" strategy reflects an individualized MDT decision-making process oriented toward the patient's functional needs. The treatment of secondary neuropathic shoulder arthropathy, including shoulder arthrodesis, shoulder resurfacing arthroplasty, reverse shoulder arthroplasty, and hemiarthroplasty, has historically led to suboptimal results [ 13 , 14 ] . Reconstruction was once considered contraindicated due to the high risk of dislocation, loosening, and implant failure attributed to muscle weakness and sensory impairment. With the application of neurosurgical decompression, Makihara et al. [ 10 ] found sensory improvement, which, although not complete normalization, provided sufficient protective sensation to consider surgical management. Arthrodesis has been progressively abandoned due to significant functional loss and unsatisfactory outcomes [ 15 , 16 ] . Shoulder resurfacing arthroplasty preserves existing humeral head and glenoid bone stock for future procedures. Crowther et al. [ 13 ] reported a case of a patient who underwent shoulder resurfacing arthroplasty and subsequent soft-tissue biologic resurfacing of the glenoid 7 years after syringomyelia decompression. Pre-arthroplasty radiographs showed no humeral head destruction. At two-year follow-up, the patient's range of motion was reasonable and unchanged compared to initial postoperative radiographs. This procedure is suitable for younger patients with neuropathic shoulder arthropathy who have adequate humeral head bone stock. The reverse shoulder arthroplasty, which has gained popularity in recent years, is indicated for patients after failure of conservative measures, with a rounded glenoid, collapsed humeral head, massive irreparable rotator cuff tear, but intact deltoid function [ 17 ] . However, serious complications such as postoperative infection, periprosthetic fracture, and prosthetic loosening make this procedure highly controversial. Schoch et al. [ 18 ] from the USA reported 10 patients who underwent shoulder arthroplasty for failed conservative treatment of Charcot shoulder, including 3 cases of reverse shoulder arthroplasty; during follow-up, 2 of these 3 cases developed acromial stress fractures. Some scholars also point out that Charcot shoulder is a contraindication for total shoulder arthroplasty due to poor bone quality, risks of prosthetic loosening, instability, and soft tissue damage [ 19 ] . Some literature shows that hemiarthroplasty with preservation or reconstruction of the rotator cuff has yielded satisfactory outcomes [ 4 , 20 ] . Matsuhashi et al. [ 20 ] performed hemiarthroplasty and rotator cuff repair on 3 neuropathic shoulders following initial neurosurgical decompression of the syrinx. At 8 years, patients experienced pain relief and increased range of motion, with no signs of prosthetic loosening. By performing rotator cuff repair concomitant with arthroplasty, they proposed that it provides better head stability, thereby reducing complication rates. In the present case, intraoperative findings included severe changes such as extensive dissolution of the humeral head, greater tuberosity defect, and rupture of the long head of the biceps tendon. Stability was achieved through hemiarthroplasty alone, combined with reconstruction of the subscapularis tendon to the original greater tuberosity footprint using 4 sutures. The one-month postoperative follow-up showed significant improvement in shoulder range of motion, a Constant-Murley score of 80, and reduced numbness on the hand dorsum, suggesting that even without addressing the primary neurological lesion, joint arthroplasty can provide significant symptomatic relief and functional improvement. Conclusion For individuals presenting with syringomyelia and concomitant end-stage Charcot arthropathy, it might be most appropriate to initially perform joint arthroplasty to manage pain and meet functional demands, deferring surgery for the underlying neurological disorder. A concerted effort towards multidisciplinary care and diligent long-term follow-up is necessary to optimize surgical strategy and enhance the patient's long-term outlook. Declarations Data availability Data is provided within the manuscript or supplementary information files. Acknowledgements not applicable. Funding This research was funded by the Science and Technology Plan Project of Zunyi City (Zunshi Kehe HZ (2022) No.333). Author information Lin Zhang and Jinglin Li contributed equally to this work. Authors and Affiliations Department of Orthopedics,Affiliated Hospital of Zunyi Medical Univeristy,Zunyi,Guizhou,563000,China Lin Zhang, Jinglin Li, Fuyin Yang, Jiaze Peng, Yang Yu, Xianpeng Huang, Xuan Deng, Xuxu Yang&Lidan Yang Author contributions L.Z. and J.L. conceived and designed the study, and wrote the initial draft and subsequentrevisions of this manuscript. F.Y. and J.P. assisted with study implementation and data collection. Y.Y., X.H., X.D. and X.Y.produced pictures and tables. L.Y. designed the study and supervised the study. All authors reviewed the manuscript. Ethics approval and consent to participate This research study was designed in accordance with ethical guidelines to ensure the protection of participants' rights and welfare. Prior to the commencement of the study, ethical approval had been obtained from the Ethics Committee of the affiliated hospital of Zunyi medical university in accordance with the declaration of Helsinki and relevant Chinese regulations. The patients was provided with an Informed Consent Form outlining the purpose of the research, procedures involved, potential risks and benefits, and measures taken to ensure confidentiality. Consent for publication In accordance with ethical guidelines and institutional policies, informed consent was obtained from the patient. The patient was provided with detailed information about the study, including its purpose, procedures, potential risks, and benefits. He voluntarily signed a“Consent to Publish” form allowing publication of anonymized data and images.the original can be provided at any time. Competing interests The authors declare no competing interests. References Fadila M, Sarrabia G, Shapira S et al. Orthopedic Manifestations of Syringomyelia: A Comprehensive Review [J]. J Clin Med, 2025, 14(9). Wawrzyniak A, Lubiatowski P. Shoulder arthropathy secondary to syringomyelia: systematic review [J]. EFORT Open Rev. 2023;8(1):26–34. Snoddy MC, Lee DH, Kuhn JE. Charcot shoulder and elbow: a review of the literature and update on treatment [J]. J Shoulder Elb Surg. 2017;26(3):544–52. Rickert MM, Cannon JG, Kirkpatrick JS. Neuropathic Arthropathy of the Shoulder: A Systematic Review of Classifications and Treatments [J]. JBJS Rev. 2019;7(10):e1. Mahmoud I, Zarrouk Z, Ben Tekaya A, et al. Neuropathic arthropathy of the shoulder as a presenting feature of Chiari malformation with syringomyelia: a case report with a systematic literature review [J]. Eur Spine J. 2022;31(10):2733–52. Flint G. Syringomyelia: diagnosis and management [J]. Pract Neurol. 2021;21(5):403–11. Olsson L, Antepohl W, Ravn SL. Active Conservative Management of Primary Spinal Syringomyelia: A Scoping Review and Perspectives for an Activity-based Clinical Approach [J]. J Rehabil Med. 2022;54:jrm00322. Grahovac G, Vilendecic M, Srdoc D. Charcot shoulder caused by Chiari type I malformation with syringomyelia with six-year follow-up [J]. Wien Klin Wochenschr. 2011;123(15–16):512–4. Deng X, Wu L, Yang C, et al. Neuropathic arthropathy caused by syringomyelia [J]. J Neurosurg Spine. 2013;18(3):303–9. Makihara T, Onishi S, Wadano Y, et al. Regrowth of the deteriorated glenoid in advanced Charcot shoulder after suboccipital decompression for syringomyelia: a case report [J]. J Shoulder Elb Surg. 2015;24(8):e223–8. Atalar AC, Sungur M, Demirhan M, et al. Neuropathic arthropathy of the shoulder associated with syringomyelia: a report of six cases [J]. Acta Orthop Traumatol Turc. 2010;44(4):328–36. Wang X, Li Y, Gao J, et al. Charcot arthropathy of the shoulder joint as a presenting feature of basilar impression with syringomyelia: A case report and literature review [J]. Med (Baltim). 2018;97(28):e11391. Crowther MA, Bell SN. Neuropathic shoulder in syringomyelia treated with resurfacing arthroplasty of humeral head and soft-tissue lining of glenoid: a case report [J]. J Shoulder Elb Surg. 2007;16(6):e38–40. Parikh JR, Houpt JB, Jacobs S, et al. Charcot's arthropathy of the shoulder following intraarticular corticosteroid injections [J]. J Rheumatol. 1993;20(5):885–7. Alpert SW, Koval KJ, Zuckerman JD. Neuropathic Arthropathy: Review of Current Knowledge [J]. J Am Acad Orthop Surg. 1996;4(2):100–8. Drvaric DM, Rooks MD, Bishop A, et al. Neuropathic arthropathy of the shoulder. A case report [J]. Orthopedics. 1988;11(2):301–4. Ueblacker P, Ansah P, Vogt S, et al. Bilateral reverse shoulder prosthesis in a patient with severe syringomyelia [J]. J Shoulder Elb Surg. 2007;16(6):e48–51. Schoch B, Werthel JD, Sperling JW, et al. Is shoulder arthroplasty an option for charcot arthropathy? [J]. Int Orthop. 2016;40(12):2589–95. Wang W, Tong A, Liu N, et al. Case series on the Charcot neuroarthropathy in hands after cervical central cord syndrome [J]. BMC Musculoskelet Disord. 2022;23(1):545. Matsuhashi T, Nagahama K, Suenaga N, et al. Midterm outcomes after humeral head replacement with rotator cuff repair in patients with syringomyelia shoulder neuroarthropathy: a report on three cases [J]. J Shoulder Elb Surg. 2011;20(8):e8–15. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7521645","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":524829493,"identity":"6106a436-4f87-47f6-a92d-a50b1c80bb95","order_by":0,"name":"Lin Zhang","email":"","orcid":"","institution":"Affiliated Hospital of Zunyi Medical Univeristy","correspondingAuthor":false,"prefix":"","firstName":"Lin","middleName":"","lastName":"Zhang","suffix":""},{"id":524829495,"identity":"04592aa7-5a25-46c9-a8c8-48b2cf2fac8a","order_by":1,"name":"Jinglin Li","email":"","orcid":"","institution":"Affiliated Hospital of Zunyi Medical 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08:14:10","extension":"xml","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":53040,"visible":true,"origin":"","legend":"","description":"","filename":"b049b4140a82404f8be5440d1f94051b1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7521645/v1/c95aaf0aa1ec7c4541bf704c.xml"},{"id":93016548,"identity":"dd3c44ef-bccd-4cbc-8013-dd7619777814","added_by":"auto","created_at":"2025-10-08 08:06:10","extension":"html","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":60052,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7521645/v1/4e3778fdd18780a10962d29a.html"},{"id":93017587,"identity":"5aad0b74-388a-4199-825c-b500943cc3d9","added_by":"auto","created_at":"2025-10-08 08:14:10","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":191953,"visible":true,"origin":"","legend":"\u003cp\u003ePreoperative cervical spine MRI. Sagittal view (A) and axial view (B). The white arrows in A and B indicate the syrinx cavity.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7521645/v1/86749359b694f5e2e1c516ee.png"},{"id":93016541,"identity":"3f1ffa59-f069-48c2-8fcf-30ccd907a00a","added_by":"auto","created_at":"2025-10-08 08:06:10","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":219025,"visible":true,"origin":"","legend":"\u003cp\u003ePreoperative right shoulder anteroposterior X-ray (A), MRI coronal view (B), CT coronal view (C), and 3D reconstruction (D). The white arrows in A-D indicate the osteolytic destruction of the humeral head.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7521645/v1/4118d630338f544720a747a4.png"},{"id":93016537,"identity":"ed3a60de-ebca-43bf-99dc-1fc6f49d8d9f","added_by":"auto","created_at":"2025-10-08 08:06:10","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":271905,"visible":true,"origin":"","legend":"\u003cp\u003eOne-month postoperative anteroposterior shoulder X-ray (A) and 3D reconstruction (B) showing the prosthesis securely in place.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7521645/v1/3d7457eb0ab3ff1bf8ece8b8.png"},{"id":94645657,"identity":"4f16d111-139a-4e1a-b521-ddb3351a8bcb","added_by":"auto","created_at":"2025-10-29 08:39:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1256436,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7521645/v1/8c2ab23d-ebff-45bf-9684-bab2b5426608.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Hemiarthroplasty for charcot shoulder arthropathy secondary to syringomyelia: a case report and literature review","fulltext":[{"header":"Background","content":"\u003cp\u003eSyringomyelia is a chronic, progressive neurological disorder characterized by cystic cavitation within the spinal cord. This lesion disrupts pain-temperature sensation and sympathetic fibers within the cord, leading to impaired protective sensation in the corresponding dermatomes and neurotrophic imbalance, which can subsequently induce neuropathic arthropathy\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. The shoulder joint is one of the most commonly affected sites, manifesting as recurrent occult trauma, rapidly progressive osteolysis, joint collapse, and instability, ultimately resulting in complete joint destruction and severe functional impairment\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. Due to the extreme rarity of Charcot shoulder secondary to syringomyelia (CSSS), there is a lack of evidence-based medical evidence and consensus guidelines, posing significant challenges in clinical decision-making. Traditional conservative treatments are of uncertain efficacy in halting joint destruction, while arthrodesis has gradually fallen out of favor due to substantial loss of function. Although total shoulder arthroplasty or reverse shoulder arthroplasty can restore some degree of mobility, neuropathic bone defects, rotator cuff and ligament insufficiency, and persistent abnormal stress significantly increase the risks of prosthetic loosening, infection, and periprosthetic fracture, leading to a high postoperative failure rate\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. Hemiarthroplasty, which preserves glenoid bone stock and involves relatively simplified procedures, is theoretically considered to potentially reduce complication rates. However, its feasibility, surgical techniques, and early functional outcomes in CSSS have only been sporadically reported in individual cases. Furthermore, patients with CSSS often initially present with joint symptoms, leading to delayed diagnosis and treatment of the primary neurological disorder, resulting in irreversible neurological damage and joint destruction. Therefore, defining surgical strategies for end-stage CSSS, optimizing multidisciplinary collaboration pathways, and evaluating long-term efficacy are of urgent clinical significance for improving patient outcomes. This study reports a case of CSSS managed by a multidisciplinary team (MDT), involving initial hemiarthroplasty combined with rotator cuff repair to reconstruct glenohumeral joint function, with planned second-stage management of the Chiari malformation and syringomyelia. A review of relevant literature is also provided to offer insights into the treatment of CSSS.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003ePreoperative Presentation\u003c/h2\u003e\u003cp\u003eA 50-year-old right-handed female patient presented with a 6-year history of dull pain and progressively worsening restricted mobility in her right shoulder, affecting activities such as hair combing and dressing. Subsequently, she developed numbness over the dorsum of the right hand in the region of the 1st to 3rd metacarpals. She had no history of diabetes or trauma. Physical examination revealed right shoulder active range of motion: forward flexion 60\u0026deg;, abduction 45\u0026deg;, extension 20\u0026deg;, and external rotation 10\u0026deg;. Hypoalgesia was noted on the dorsum of the right hand. Laboratory findings: CRP and ESR were normal; Glycated hemoglobin (HbA1c) was 5.2%. Cervical spine MRI revealed a syrinx extending from C2 to T5, with a maximum width of 7 mm, and cerebellar tonsillar descent (Chiari I malformation) of 8 mm. Right shoulder X-ray and CT showed osteolytic bone destruction of the articular components and dislocation of the right glenohumeral joint. MRI of the right shoulder demonstrated loss of the glenoid structure, a large defect in the humeral head, a large joint effusion, and extensive edema in the periarticular soft tissues. Diagnosis: 1. Syringomyelia with Chiari Malformation Type I; 2. Right Charcot Shoulder Arthropathy; 3. Right Shoulder Dislocation.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSurgical Management\u003c/h3\u003e\n\u003cp\u003eFollowing multidisciplinary discussion, right shoulder hemiarthroplasty was performed first. Under general anesthesia, the patient was placed in the beach-chair position. After standard sterilization and draping, a deltopectoral approach approximately 10 cm long, starting at the coracoid process, was utilized. Electrocautery was used to incise the skin, subcutaneous tissue, and superficial fascia sequentially. The interval between the deltoid and pectoralis major was developed, retracting a small portion of muscle fibers and the cephalic vein medially to expose the rotator cuff, joint capsule, and the insertion of the pectoralis major tendon. Intraoperative examination revealed a ruptured and retracted long head of the biceps tendon, which was tagged. The joint capsule was incised, and the subscapularis tendon was reflected anteriorly along with the capsule. Exploration showed near-complete dissolution of the greater tuberosity, a residual portion of the lesser tuberosity, and extensive dissolution of the anterior and inferior half of the humeral head, with partial loss of posterior cartilage and subchondral bone. After orientation, the remaining humeral head was resected using a precision bone saw system. The proximal humeral medullary canal was reamed. A size 2 trial stem was inserted, referencing the bicipital groove, and the height was determined based on the pectoralis major tendon insertion. Granulation tissue and bone fragments within the joint were debrided. A Lima SMR size 50 CTA humeral head trial was placed, demonstrating satisfactory fit and stability, confirmed by intraoperative fluoroscopy. The corresponding definitive prosthesis was implanted. Shoulder mobility was checked in all directions and found to be satisfactory without instability. The subscapularis tendon was repaired and sutured near the original footprint of the greater tuberosity using sutures. The long head of the biceps tendon was tenodesed locally. Shoulder range of motion was reassessed and remained satisfactory. The surgery concluded. The Chiari malformation and syringomyelia were indicated for surgery, planned as an elective suboccipital decompression at a later date.\u003c/p\u003e\n\u003ch3\u003ePostoperative Outcome\u003c/h3\u003e\n\u003cp\u003eAt the one-month postoperative follow-up, numbness on the dorsum of the right hand had significantly decreased. The range of motion of the right shoulder had markedly improved in all directions. The shoulder Constant-Murley score was 80.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eCharcot shoulder arthropathy is a condition that occurs in patients with neurological disorders, progresses slowly, and causes joint damage that affects activities of daily living. One of its primary causes is syringomyelia in the cervical region\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. Syringomyelia complicated by Charcot shoulder arthropathy (CSSS) is a rare and highly debilitating neuropathic joint disorder. Its core pathology involves dual impairment of pain-temperature sensation and sympathetic fibers due to the syrinx, causing the glenohumeral joint to endure abnormal mechanical stress without neuroprotective feedback, ultimately leading to bony fragmentation and joint dislocation\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. The 50-year-old female patient in this case, with a 6-year history of right shoulder pain and dysfunction, imaging showing significant humeral head dissolution and glenohumeral dislocation, accompanied by a C2-T5 syrinx and Chiari Malformation Type I, represents a typical presentation of CSSS.\u003c/p\u003e\u003cp\u003eThe goals of treatment for patients with neuropathic arthropathy are early diagnosis, preservation of joint and limb function, and management of the underlying disease. However, there are currently no consensus guidelines in the literature regarding the treatment of syringomyelia-associated neuropathic arthropathy. Treatment modalities range from conservative approaches such as rehabilitation, joint protection strategies, patient education, and analgesics, to surgical interventions including arthrodesis, prosthetic arthroplasty, and neurosurgical procedures\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. Management of CSSS must address both the primary neurological disease and the secondary joint pathology. Although conservative methods are often the initial treatment choice, the low prevalence of Charcot shoulder and the lack of long-term follow-up data make it difficult to ascertain the effectiveness of non-surgical therapy alone for Charcot shoulder\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. According to the literature, surgical intervention is considered a reasonable treatment option for reducing pain and improving functional status in patients with CSSS. These interventions may be pursued after conservative management fails. For selected patients, surgical treatment may be considered as a primary option.\u003c/p\u003e\u003cp\u003eFor the primary disease, the main goal of intervention is to prevent further expansion of the syrinx and avoid damage to the remaining spinal cord. Existing data suggest that early treatment of the primary neurological disease may halt the progression of Charcot arthropathy. Grahovac et al.\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e reported a case of Charcot shoulder caused by Chiari I malformation with syringomyelia where, at 6-year follow-up after craniocervical decompression, there was no significant progression of the syrinx or joint pathology. Deng et al.\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e studied 12 patients with Charcot arthropathy caused by syringomyelia and found that 5 patients who underwent neurosurgical treatment for the primary disease showed improvement in neurological dysfunction postoperatively, without worsening of related joint symptoms. Among the 7 patients who did not undergo surgery, 5 experienced progression of joint destruction and neurological deterioration. Makihara et al.\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e reviewed a patient with Charcot shoulder who underwent suboccipital decompression for syringomyelia, showing improved proximal muscle strength, reduced sensory changes, and over time, bone regeneration resembling a new joint surface. Atalar et al.\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e reviewed 5 patients with syringomyelia and neuropathic shoulder arthropathy. Four patients underwent neurosurgical decompression and conservative treatment for the neuropathic joint, while one did not undergo syrinx decompression. All patients who received neurosurgical decompression showed improvements in the range of motion and function of the neuropathic joint. However, for patients who have developed end-stage structural destruction, decompression alone is often insufficient to restore joint function, and joint reconstruction still relies on arthroplasty.\u003c/p\u003e\u003cp\u003eMany patients often present with joint symptoms preceding neurological symptoms. Once Charcot arthropathy is observed, the disease is often at an advanced stage, making treatment challenging\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. In this case, while the Chiari malformation and syringomyelia had clear indications for neurosurgery, the MDT decided to perform hemiarthroplasty first, followed by second-stage craniocervical decompression, primarily based on: 1) The joint was dislocated with massive bone defects, and delayed reconstruction would further increase bone loss in the glenoid and proximal humerus; 2) Neurological symptom progression was relatively slow (only numbness on the hand dorsum), suggesting a controllable risk of syrinx expansion in the short term; 3) Stabilizing the shoulder joint first could provide a tolerable basis for early postoperative rehabilitation following the second-stage suboccipital decompression. This \"reverse sequential\" strategy reflects an individualized MDT decision-making process oriented toward the patient's functional needs.\u003c/p\u003e\u003cp\u003eThe treatment of secondary neuropathic shoulder arthropathy, including shoulder arthrodesis, shoulder resurfacing arthroplasty, reverse shoulder arthroplasty, and hemiarthroplasty, has historically led to suboptimal results\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. Reconstruction was once considered contraindicated due to the high risk of dislocation, loosening, and implant failure attributed to muscle weakness and sensory impairment. With the application of neurosurgical decompression, Makihara et al.\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e found sensory improvement, which, although not complete normalization, provided sufficient protective sensation to consider surgical management.\u003c/p\u003e\u003cp\u003eArthrodesis has been progressively abandoned due to significant functional loss and unsatisfactory outcomes\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. Shoulder resurfacing arthroplasty preserves existing humeral head and glenoid bone stock for future procedures. Crowther et al.\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e reported a case of a patient who underwent shoulder resurfacing arthroplasty and subsequent soft-tissue biologic resurfacing of the glenoid 7 years after syringomyelia decompression. Pre-arthroplasty radiographs showed no humeral head destruction. At two-year follow-up, the patient's range of motion was reasonable and unchanged compared to initial postoperative radiographs. This procedure is suitable for younger patients with neuropathic shoulder arthropathy who have adequate humeral head bone stock. The reverse shoulder arthroplasty, which has gained popularity in recent years, is indicated for patients after failure of conservative measures, with a rounded glenoid, collapsed humeral head, massive irreparable rotator cuff tear, but intact deltoid function\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. However, serious complications such as postoperative infection, periprosthetic fracture, and prosthetic loosening make this procedure highly controversial. Schoch et al.\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e from the USA reported 10 patients who underwent shoulder arthroplasty for failed conservative treatment of Charcot shoulder, including 3 cases of reverse shoulder arthroplasty; during follow-up, 2 of these 3 cases developed acromial stress fractures.\u003c/p\u003e\u003cp\u003eSome scholars also point out that Charcot shoulder is a contraindication for total shoulder arthroplasty due to poor bone quality, risks of prosthetic loosening, instability, and soft tissue damage\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. Some literature shows that hemiarthroplasty with preservation or reconstruction of the rotator cuff has yielded satisfactory outcomes\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. Matsuhashi et al.\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e performed hemiarthroplasty and rotator cuff repair on 3 neuropathic shoulders following initial neurosurgical decompression of the syrinx. At 8 years, patients experienced pain relief and increased range of motion, with no signs of prosthetic loosening. By performing rotator cuff repair concomitant with arthroplasty, they proposed that it provides better head stability, thereby reducing complication rates. In the present case, intraoperative findings included severe changes such as extensive dissolution of the humeral head, greater tuberosity defect, and rupture of the long head of the biceps tendon. Stability was achieved through hemiarthroplasty alone, combined with reconstruction of the subscapularis tendon to the original greater tuberosity footprint using 4 sutures. The one-month postoperative follow-up showed significant improvement in shoulder range of motion, a Constant-Murley score of 80, and reduced numbness on the hand dorsum, suggesting that even without addressing the primary neurological lesion, joint arthroplasty can provide significant symptomatic relief and functional improvement.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eFor individuals presenting with syringomyelia and concomitant end-stage Charcot arthropathy, it might be most appropriate to initially perform joint arthroplasty to manage pain and meet functional demands, deferring surgery for the underlying neurological disorder. A concerted effort towards multidisciplinary care and diligent long-term follow-up is necessary to optimize surgical strategy and enhance the patient's long-term outlook.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData is provided within the manuscript or supplementary information files.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003enot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was funded by the Science and Technology Plan Project of Zunyi City (Zunshi Kehe HZ (2022) No.333).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLin Zhang and Jinglin Li contributed equally to this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors and Affiliations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDepartment of Orthopedics,Affiliated Hospital of Zunyi Medical Univeristy,Zunyi,Guizhou,563000,China\u003c/p\u003e\n\u003cp\u003eLin Zhang, Jinglin Li, Fuyin Yang, Jiaze Peng, Yang Yu, Xianpeng Huang, Xuan Deng, Xuxu Yang\u0026amp;Lidan Yang\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eL.Z. and J.L. conceived and designed the study, and wrote the initial draft and subsequentrevisions of this manuscript. F.Y. and J.P. assisted with study implementation and data collection. Y.Y., X.H., X.D. and X.Y.produced pictures and tables. L.Y. designed the study and supervised the study. All authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research study was designed in accordance with ethical guidelines to ensure the protection of participants\u0026apos; rights and welfare. Prior to the commencement of the study, ethical approval had been obtained from the Ethics Committee of the affiliated hospital of Zunyi medical university in accordance with the declaration of Helsinki and relevant Chinese regulations. The patients was provided with an Informed Consent Form outlining the purpose of the research, procedures involved, potential risks and benefits, and measures taken to ensure confidentiality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn accordance with ethical guidelines and institutional policies, informed consent was obtained from the patient. The patient was provided with detailed information about the study, including its purpose, procedures, potential risks, and benefits. He voluntarily signed a\u0026ldquo;Consent to Publish\u0026rdquo;\u0026nbsp;form allowing publication of anonymized data and images.the original can be provided at any time.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFadila M, Sarrabia G, Shapira S et al. Orthopedic Manifestations of Syringomyelia: A Comprehensive Review [J]. J Clin Med, 2025, 14(9).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWawrzyniak A, Lubiatowski P. Shoulder arthropathy secondary to syringomyelia: systematic review [J]. EFORT Open Rev. 2023;8(1):26\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSnoddy MC, Lee DH, Kuhn JE. Charcot shoulder and elbow: a review of the literature and update on treatment [J]. J Shoulder Elb Surg. 2017;26(3):544\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRickert MM, Cannon JG, Kirkpatrick JS. Neuropathic Arthropathy of the Shoulder: A Systematic Review of Classifications and Treatments [J]. JBJS Rev. 2019;7(10):e1.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMahmoud I, Zarrouk Z, Ben Tekaya A, et al. Neuropathic arthropathy of the shoulder as a presenting feature of Chiari malformation with syringomyelia: a case report with a systematic literature review [J]. Eur Spine J. 2022;31(10):2733\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFlint G. Syringomyelia: diagnosis and management [J]. Pract Neurol. 2021;21(5):403\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOlsson L, Antepohl W, Ravn SL. Active Conservative Management of Primary Spinal Syringomyelia: A Scoping Review and Perspectives for an Activity-based Clinical Approach [J]. J Rehabil Med. 2022;54:jrm00322.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGrahovac G, Vilendecic M, Srdoc D. Charcot shoulder caused by Chiari type I malformation with syringomyelia with six-year follow-up [J]. Wien Klin Wochenschr. 2011;123(15\u0026ndash;16):512\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDeng X, Wu L, Yang C, et al. Neuropathic arthropathy caused by syringomyelia [J]. J Neurosurg Spine. 2013;18(3):303\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMakihara T, Onishi S, Wadano Y, et al. Regrowth of the deteriorated glenoid in advanced Charcot shoulder after suboccipital decompression for syringomyelia: a case report [J]. J Shoulder Elb Surg. 2015;24(8):e223\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAtalar AC, Sungur M, Demirhan M, et al. Neuropathic arthropathy of the shoulder associated with syringomyelia: a report of six cases [J]. Acta Orthop Traumatol Turc. 2010;44(4):328\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang X, Li Y, Gao J, et al. Charcot arthropathy of the shoulder joint as a presenting feature of basilar impression with syringomyelia: A case report and literature review [J]. Med (Baltim). 2018;97(28):e11391.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCrowther MA, Bell SN. Neuropathic shoulder in syringomyelia treated with resurfacing arthroplasty of humeral head and soft-tissue lining of glenoid: a case report [J]. J Shoulder Elb Surg. 2007;16(6):e38\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eParikh JR, Houpt JB, Jacobs S, et al. Charcot's arthropathy of the shoulder following intraarticular corticosteroid injections [J]. J Rheumatol. 1993;20(5):885\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlpert SW, Koval KJ, Zuckerman JD. Neuropathic Arthropathy: Review of Current Knowledge [J]. J Am Acad Orthop Surg. 1996;4(2):100\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDrvaric DM, Rooks MD, Bishop A, et al. Neuropathic arthropathy of the shoulder. A case report [J]. Orthopedics. 1988;11(2):301\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eUeblacker P, Ansah P, Vogt S, et al. Bilateral reverse shoulder prosthesis in a patient with severe syringomyelia [J]. J Shoulder Elb Surg. 2007;16(6):e48\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSchoch B, Werthel JD, Sperling JW, et al. Is shoulder arthroplasty an option for charcot arthropathy? [J]. Int Orthop. 2016;40(12):2589\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang W, Tong A, Liu N, et al. Case series on the Charcot neuroarthropathy in hands after cervical central cord syndrome [J]. BMC Musculoskelet Disord. 2022;23(1):545.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMatsuhashi T, Nagahama K, Suenaga N, et al. Midterm outcomes after humeral head replacement with rotator cuff repair in patients with syringomyelia shoulder neuroarthropathy: a report on three cases [J]. J Shoulder Elb Surg. 2011;20(8):e8\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Syringomyelia, Charcot shoulder arthropathy, hemiarthroplasty, Case report","lastPublishedDoi":"10.21203/rs.3.rs-7521645/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7521645/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSyringomyelia complicated by Charcot shoulder arthropathy is a severely debilitating neuropathic joint disorder. The core pathology involves dual impairment of pain-temperature sensation and sympathetic fibers due to the syrinx, leading the glenohumeral joint to endure abnormal mechanical stress without neuroprotective feedback, resulting in progressive osseous and articular destruction. However, due to the rarity of this condition, its management remains highly controversial. This article reports a case of hemiarthroplasty for Charcot shoulder arthropathy caused by syringomyelia and reviews the relevant literature for reference.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase Presentation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA 50-year-old female patient presented to our hospital with a 6-year history of right shoulder pain and restricted mobility. Examinations confirmed syringomyelia with concomitant right-sided Charcot shoulder arthropathy and glenohumeral dislocation. The patient underwent hemiarthroplasty of the humeral head combined with rotator cuff repair to address the joint pathology. The management of the syringomyelia and associated Chiari malformation was planned for a second-stage surgery. At the one-month postoperative follow-up, numbness on the dorsum of the right hand had significantly decreased, the range of motion (ROM) of the right shoulder had markedly improved, and the shoulder Constant-Murley score was 80.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePrioritizing joint arthroplasty to address secondary Charcot arthropathy for pain relief and functional improvement, followed by elective surgery for the primary neurological disorder, may be a more suitable strategy for patients with syringomyelia and end-stage Charcot shoulder arthropathy. Multidisciplinary collaboration and long-term follow-up are essential for optimizing surgical strategies and improving long-term outcomes in these patients.\u003c/p\u003e","manuscriptTitle":"Hemiarthroplasty for charcot shoulder arthropathy secondary to syringomyelia: a case report and literature review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-08 08:06:05","doi":"10.21203/rs.3.rs-7521645/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7323e580-aa85-48b2-8785-17fb8e5dc302","owner":[],"postedDate":"October 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-29T08:38:54+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-08 08:06:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7521645","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7521645","identity":"rs-7521645","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}