Is thermo-algesic loss of sensibility the cause of neuropathic arthropathy ?
Mr Julien SCHEMOULa, Prof Gilles RODEa, Dr Andre BASCHa, Prof François COTTONa
Neuropathic arthropathy of the shoulder is a rare condition and its physiopathology is unclear. It frequently leads to the discovering of syringomyelia, which is one of the most frequent etiology. The physiopathology would be based on loss of sensibility. Our case is original because it concerns a patient with only a thermoalgesic deficit but without any anesthesia of the shoulder.
The patient is quadraplegic C7 by C6-C7 luxation because of a car accident which occured in 1986. In 2013 he started complaining about stiffness of the left shoulder which began progressively without initial trauma. X-rays and clinical examination made us diagnose shoulder arthrosis and capsulitis. The stiffness progressively got worse in spite of appropriate physical therapy and glucocorticoid intra-articular infiltration. Neurological examination showed sensibility loss, more pronounced on the left side, which deteriorated in 2013. At the same time a medullar MRI had shown unknown left postero-lateral C4-C5 syringomyelia. The stiffness progressively worsen so we asked for a CT-Scan. It showed a neurogenic arthropathy of the shoulder.
The OAN physiopathology is unclear, there is two hypothesis: the neuro-traumatic diagnosis and the neuro-vascular diagnosis. Both are probably linked and have a common beginning: a sensibility loss.
The new thing in this case is the the maintaining of the tactile sensibility of the shoulder, whereas there is an evident loss of thermo-algesic sensibility. This is probably because of a selective compression of certain nerve fibre by the syringomyelia.
Keywords : neuropathic arthropathy, syringomyelia, physiopathology, thermoalgesic, quadraplegic, MRI, stiffness