Charcot Arthropathy of the Shoulder With Ipsilateral Wrist and First Carpometacarpal Joint Involvement Secondary to Chiari Malformation Type I With Syringomyelia.

Charcot arthropathy of the shoulder is a rare manifestation of neuropathic joint disease and is most commonly associated with syringomyelia. When present, it often results in progressive joint destruction, but, due to minimal pain, it leads to delayed diagnosis. We report the case of a 54-year-old female presenting with a three-month history of left shoulder swelling, deformity, and severe restriction of range of motion, associated with ipsilateral wrist deformity. The patient had a known history of Chiari malformation type I with syringomyelia. Clinical examination revealed marked shoulder deformity with severe restriction of active motion and reduced sensation in the affected limb. Radiographs demonstrated advanced destructive changes of the glenohumeral joint with humeral head deformity and loose bodies. MRI revealed extensive shoulder joint effusion, rotator cuff muscle atrophy with relative deltoid preservation, and an extensive cervical syrinx extending from C2 to C7. A diagnosis of neuropathic (Charcot) arthropathy of the shoulder secondary to Chiari malformation with syringomyelia was established. Additional imaging showed obliteration of the first carpometacarpal (CMC) joint with subchondral sclerosis, cystic changes, and volar subluxation of the first metacarpal, as well as early degenerative changes at the ipsilateral elbow. The patient was managed conservatively with analgesics, protective measures, and multidisciplinary follow-up. Charcot arthropathy of the shoulder is an uncommon but important complication of syringomyelia associated with Chiari malformation type I. This case highlights the importance of early recognition of neuropathic arthropathy in patients with neurological disease. The combined involvement of the shoulder, wrist, and first CMC joint represents an unusual pattern of upper-limb neuropathic arthropathy and contributes to the existing literature on multi-joint involvement.