1201 - Charcot Elbow in the setting of Post Traumatic Syringomyelia

Thursday, February 22, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

CB

Colton A. Besett, MD

Physical Medicine and Rehabilitation Resident Physician
UTHealth Houston
Houston, Texas, United States

Co-Author(s)

Joel E. Frontera, MD

Associate Professor and Vice Chair for Education
McGovern Medical School at UTHealth Houston
Houston, Texas, United States

Presenting Author(s)

LS

Laura Serrano-Ortiz, MD

SCIM Fellow Physician
McGovern Medical School at UTHealth Houston
Houston, Texas, United States

Case Diagnosis: T5 AIS A Spinal Cord Injury with Charcot Elbow in the setting of Post Traumatic Syringomyelia

Case Description: A 52-year-old male with T5 AIS A paraplegia with syringomyelia s/p syringoperitoneal shunt presented for chronically progressive, painless left upper extremity swelling and decreased function. The left elbow was significantly swollen and elbow range of motion and strength were reduced. As part of the workup, surgical exploration discovered a malfunctioned shunt, and a new shunt was placed at T1. Over one week, the left arm swelling improved, but he developed decreased sensation and progressive weakness. MRI spine showed a left hemicord hemorrhage between C3-C6 and a possible free syrinx between C2-C3. No acute interventions were deemed necessary by the neurosurgery team, and he was discharged to inpatient rehabilitation (IPR). During IPR, the motor function of the left elbow did not improve. An updated ISNCSCI exam revealed a change in the neurologic level of injury to C1 due to decreased sensation to pinprick at C2 on the right side.

Discussions: If a syringomyelia develops after a traumatic spinal cord injury, then it is defined as post-traumatic syringomyelia (PTS). PTS can damage the spinothalamic tract, resulting in loss of pain and temperature sensation triggering a cascade of events that ultimately leads to bone resorption. Surgical management is suggested to be reserved only for progressive motor weakness and typically does not improve symptoms of sensation. Conservative measures include pain management and improving physical function in the affected joint.

Conclusions: In traumatic spinal cord injury patients who have an insidious onset of painless elbow joint swelling that causes reduced function, spinal MRI should be obtained to search for concurrent PTS. Surgical evaluation is reserved for motor weakness in the setting of PTS. Inpatient rehabilitation should be considered to improve physical function and maximize independence.