A 35-year-old man has a grossly swollen, unstable shoulder joint with marked disuse but minimal pain. Radiographs show severe destruction of the humeral head and glenoid. Cervical MRI demonstrates a central syrinx. The most likely cause of this neuropathic arthropathy is:

• A Diabetic peripheral neuropathy
• B Charcot-Marie-Tooth disease
• C Tabes dorsalis
• D Syringomyelia ✓

Explanation

The distribution of Charcot arthropathy follows the underlying neuropathy: diabetes affects the foot and ankle, tabes dorsalis affects the lower limbs and spine, and syringomyelia classically affects the upper limb, especially the shoulder and elbow. A painless destructive shoulder with disproportionate swelling and instability in a young adult should prompt cervical imaging, and the syrinx confirms the diagnosis.

Reference: Miller's Review of Orthopaedics, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.