Charcot Elbow Joint as the Initial Symptom in Chiari Malformation with Syringomyelia.

Charcot joint (CJ), also known as neurotrophic arthropathy, is secondary to diabetes, syringomyelia, spinal tuberculosis, etc. The clinical manifestations are varied. The main performance includes pain, slightly restricted joint movement and very obvious swelling and damage of joint. It is easy to be misdiagnosed when the joint is the first symptom. We report a case of Charcot elbow joint as the initial symptom in Chiari malformation with syringomyelia. A 44‑year‑old woman was admitted to our hospital with a 3‑month history of left elbow pain. Three months ago, she had an onset of left elbow pain without apparent inducement. The pain was mild and intermittent. Her left elbow got swelling and deformity but the activities were not limited. Shortly afterward atrophy of the left‑thenar muscle and numbness of ulnar two fingers on left hand had begun to surface. Her physical examination indicated left elbow deformity, swelling, bone rubbing feeling after the activity, without pain or tenderness in joint activity. The tactile, pain and temperature sensation below the left elbow decreased. The topesthesia and graphesthesia were normal yet. Double Hoffman and Babinski signs were also negative. X‑ray films [Figure 1a] in outer court showed the destruction and abnormality of the left elbow joint. Cervical magnetic resonance imaging (MRI) [Figure 1b] in our hospital pointed out: Chiari malformation associated with syringomyelia. Patient underwent local brake of the left elbow joints immediately and craniocervical decompression within 3 days after initial admission. After symptomatic treatment postoperation, the pain of left elbow and the numbness on the left hand were relieved. Three days after the operation, MRI [Figure 1c] showed that the cerebellar retraction was good, and syringomyelia was significantly reduced. Half a year after discharge, review of MRI [Figure 1d] showed syringomyelia had no significant change. CJ was described in detail for the 1 st time by a French Doctor Charcot in 1868, which was a destructive joint disease due to abnormal sensory nerve and nervous nutritional disorders. It is more common in adults and patients over the age of 40. Mostly one joint is involved, and sometimes two or three joints maybe. CJ has an occult onset. It has only sensory nerve involvement and no motor nerve invasion, so it would not affect body movement. Frequent symptoms include the swelling and relaxation of the joint, abnormal activity, numbness of the affected limb, hypalgesia or analgesia, walking instability. It even has a deformity or overactive …