Neuropathic arthropathy of the elbow - A report of five cases

Background: Neuropathic arthropathy of the elbow is rare and characterized by a painless but unstable articulation. The functional capacity of patient s with this condition has not been reviewed in detail. Methods: Five male patients, with an average age of fifty-one years, were t reated for neuropathic arthropathy of the elbow. The underlying conditions associated with the arthropathy included syringomyelia, insulin-dependent d iabetes mellitus, end-stage renal failure, and two cases of polyneuropathy of unknown cause. Four patients sought medical attention after a specific t raumatic event. Peripheral sensory and motor dysfunction was present in eac h patient. Radiographs of the elbow revealed dislocation, fracture fragment ation, and heterotopic ossification. Our management of the neuropathic elbo ws centered on maintenance of a functional are of motion through physical t herapy aimed at regaining muscle strength and the use of orthoses for suppo rt. Operative treatment was performed for an associated ulnar or radial ner ve compression syndrome in three patients, and an open reduction and intern al fixation of an unstable proximal ulnar nonunion associated with loose im plants was performed in one. Results: The patients were followed for an average of nineteen months, with a range of twelve to thirty-six months. All patients had a pain-free elbow with a functional range of motion at the most recent follow-up examination , and none wished to have further treatment. The operatively treated ulnar nonunion united successfully. All three patients treated surgically for an associated nerve compression syndrome had recovery of nerve function. Conclusion: In the face of instability and gross distortion of the joint, t he patients in this series demonstrated remarkably good function.