1227 - Post-traumatic syringomyelia with unilateral symptoms preceding development of ipsilateral shoulder charcot arthropathy in two chronic spinal cord injury patients.

Case Diagnosis: Two spinal cord injury (SCI) patients developed left upper extremity sensory changes and were diagnosed with post-traumatic syringomyelia (PTS). They subsequently developed left shoulder pain, swelling, and stiffness, and were diagnosed with severe charcot arthropathy (CA).

Case Description: Two cases of female SCI patients, a 59-year-old T3 incomplete and a 43-year-old T4 ASIA A, who developed left upper extremity sensory changes over 4 years after their original injury, one with complete numbness and one with paresthesia and loss of temperature sensation. Both underwent spinal MRI and were diagnosed with cervicothoracic syringiomyelia which was not drained. Years later, both women presented with left shoulder pain, stiffness, and swelling. Imaging revealed severe CA with persistent syrinx on MRI. Syrinxes were drained and the women underwent conservative treatment with minimal symptomatic or functional improvement.

Discussions: CA is a rare degenerative condition that occurs in joints of extremities with abnormal sensation and proprioception. In SCI patients, CA is most commonly seen in the spine and lower extremities. Shoulder CA is a rare but known complication of Syringiomelia. About 4% of chronic SCI patients develop symptomatic PTS in their life-time. There is a paucity of research regarding prevalence of shoulder CA relating to symptomatic PTS in the SCI population. Presenting symptoms of CA include swelling, stiffness, and laxity of the joint, and pain may occur as a late manifestation. Early diagnosis is the mainstay to successful management with syrinx drainage and conservative treatment; however, SCI patients rarely present early, leading to poor prognosis.

Conclusions: This case highlights the importance of early diagnosis and management of shoulder CA in the SCI population. SCI patients who develop symptomatic syringomyelia should be educated on the risk of developing CA in the symptomatic limb to decrease latency of presentation and diagnosis of this disabling degenerative condition, as timing of diagnosis significantly effects prognosis.