Unusual case offers educational opportunity

After this preliminary year in internal medicine, Evelyn Qin, MD, MPH, is headed into her physical medicine and rehabilitation residency, and she will carry with her plenty of experience in slightly more obscure corners of this specialty. Qin recently worked with Brittany Bettendorf, MD, clinical assistant professor in Immunology, to analyze an unusual case. The case involved a 69-year-old man with a 20-year history of severe cervicothoracic myelopathy, a cyst on the vertebrae in the upper and middle spine, and repaired Chiari malformation, a condition in which brain tissue extends into the spinal canal.

The man reported spontaneous swelling in his elbows and decreased range of motion in his elbows and wrists for the past 15 years. Additionally, his hands gradually became weak and numb. Causes, including diabetes, were ruled out. The resulting workup, the images produced, and their diagnosis were recently published in the Journal of Clinical Rheumatology.

In the physical examination, the clinicians found deformities in his wrist and elbows. Radiographs of the elbows and wrists revealed joint destruction consistent with neuropathic arthropathy, also known as Charcot joints. Charcot arthropathy is usually associated with the foot, but Qin and Bettendorf wanted to raise awareness that this can occur with other conditions as well, such as in cervical myelopathy.

“We were excited to publish this data because most people tend to associate Charcot joints with diabetes and occurring in the feet,” Qin said. “However, as this case shows, patients do not need to have diabetes and, depending on the underlying condition, can present with Charcot joints in the elbows and wrists as well.”

Leave a Reply