Neuropathic Arthropathy of the Elbow: A Report of Two Cases
Aasis Unnanuntana MD*, Saranatra Waikakul MD*
Affiliation : * Department of Orthopaedic Surgery, Siriraj Hospital, Mahidol University
Background : Neuropathic arthropathy (charcot joint) of the elbow is a rare condition. It is among the least
frequently reported charcot pathology of the joint. The clinical symptoms are characterized by a painless and
unstable joint. Infection in the neuropathic joint is rare. Only a limited number of cases have been reported in
the literature. The authors present two cases of neuropathic arthropathy of the elbow. One of them was
diagnosed as Septic neuropathic arthropathy.
Materials and Methods : Two patients with neuropathic arthropathy of the elbow (an infected and a non-
infected case) were treated at our department. Both patients were over 60 years old. The underlying condi-
tions associated with the arthropathy included combined median and ulnar neuropathy in the infected case
and idiopathic in the non-infected case. Both of the patients had a history of specific trauma at the affected
elbows. The radiographs of the elbows revealed dislocation, fracture fragmentation and some bony sclerosis.
The management in the non-infected case aimed to maintain the function of the elbow with a short period of
immobilization and physical therapy. For the infected case, the patient was treated successfully with systemic
antibiotic, surgical debridement and a period of immobilization with an external fixator.
Results : The patients were followed-up for approximately 9 months for the non-infected and 2 years for the
infected case. Both of them had painless and functional range of motion of the elbows in the most recent
follow-up examination. For the infected case, the surgical incision healed well and there was no recurrent
discharge from that affected elbow.
Conclusion : In the first case, with neuropathic arthropathy of the elbow, the investigations were made to
find the underlying disease. The second case with septic neuropathic joint, systemic antibiotic, surgical
debridement and appropriate immobilization were needed. With gross instability and marked distortion of
the joint, the elbow of both patients functioned remarkably well.
Keywords : Neuropathic arthropathy, Charcot joint, Elbow, Septic, Infected joint, Idiopathic, Combined median and ulnar nerve palsy
