Radiology Teaching Files > Case 48053238

Contributed by: Steven Craig, Radiologist, Brooke Army Medical Center, Texas, USA.
Patient: 72 year old
History: 72 year old patient with several years of progressive shoulder pain. Hx of DM

Fig. 1

Fig. 2: Severe degenerative changes of the right shoulder with penciling of the distal clavicle

Fig. 3

Fig. 4: Near complete erosion of the glenoid

Fig. 5: Anterior subluxation of the humerus and erosion of the glenoid

Fig. 6: Degenerative disease of the humeral head with near complete erosion of the glenoid and a large joint capsule filled with inflammatory debris

Fig. 7: Severe cortical thinning and cystic degeneration of the proximal humerus with associated fracture.
Findings: Severe erosive changes of the distal clavicle, humeral head, and acromion with complete erosion of the glenoid.  Suspect pseudoarticulation of the hunerus with the clavicle.
Diagnosis: neuropathic joint
Discussion: Initially, this was thought to be gout vs rheumatoid arthritis.  We favored RA given the penciling of the distal clavicle.  However, comparison exams from just a couple of years ago showed rapid deterioration over a short time period.  This combined with the possiblilty of psuedoarticulation of the humeral head with the clavicle in the setting of DM let to the Dx of neuropathic joint.
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Additional Details:

Case Number: 48053238Last Updated: 11-03-2010
Anatomy: Skeletal System   Pathology: Non-Infectious Inflammatory Disease
Modality: Conventional Radiograph, MRAccess Level: Readable by all users
Keywords: neuropathic joint

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