Foramen magnum decompression and arthrodesis in a septic, neuropathic elbow: A case report

Abstract

Neuropathic arthropathy is a chronic progressive degenerative joint disorder associated with abnormal sensory innervation of a joint. This article presents a patient of a forty seven year old man who came with a swollen, painful, deformed elbow with discharging wound associated with fever. He had multiple consultations elsewhere for the same. Magnetic resonance imaging (MRI) of elbow and open biopsy was done. He was advised above elbow amputation with a diagnosis of infected, ulcerated, giant cell tumour of tendon sheath. He refused amputation and presented to us with a request for limb salvage. Neurological examination revealed sensory and motor deficiencies in the left upper limb. His total leucocyte count, erythrocyte sedimentation rate (ESR) were elevated. Culture of pus has shown growth of methicillin sensitive staphylococcus aureus. Resorption of the articulating surfaces with elbow dislocation and flecks of calcification in the diffuse soft tissue mass around the elbow were noted in the elbow radiograph. MRI of cervical spine revealed Chiari type I malformation with syringomyelia. Critical review and Second opinion of biopsy was suggestive of neuropathic arthropathy. Debridement and elbow arthrodesis was done under antibiotic cover. Foramen magnum decompression was done subsequently. Following the neuronal decompression neurological symptoms improved and bridging bony callus was noted across the elbow. To the best of our knowledge a rare presentation of septic, neuropathic elbow with Chiari malformation and syringomyelia treated successfully with elbow arthrodesis and foramen magnum decompression is not yet reported in the literature.

Keywords

• neuropathic arthropathy
• syringomyelia
• Chiari malformation
• septic arthritis
• arthrodesis
• foramen magnum decompression