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The Journal of Bone and Joint Surgery (American) 83:839-844 (2001)
© 2001 The Journal of Bone and Joint Surgery, Inc.

Neuropathic Arthropathy of the Elbow

A Report of Five Cases

Carl A. Deirmengian, MD, Sang-Gil P. Lee, MD and Jesse B. Jupiter, MD

Investigation performed at the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
Carl A. Deirmengian, MD
University of Pennsylvania, School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104

Sang-Gil P. Lee, MD
Jesse B. Jupiter, MD
Massachusetts General Hospital, 15 Parkman Street, ACC 527, Boston, MA 02114. E-mail address for J.B. Jupiter: jjupiter1{at}partners.org

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study.

Background: Neuropathic arthropathy of the elbow is rare and characterized by a painless but unstable articulation. The functional capacity of patients with this condition has not been reviewed in detail.

Methods: Five male patients, with an average age of fifty-one years, were treated for neuropathic arthropathy of the elbow. The underlying conditions associated with the arthropathy included syringomyelia, insulin-dependent diabetes mellitus, end-stage renal failure, and two cases of polyneuropathy of unknown cause. Four patients sought medical attention after a specific traumatic event. Peripheral sensory and motor dysfunction was present in each patient. Radiographs of the elbow revealed dislocation, fracture fragmentation, and heterotopic ossification. Our management of the neuropathic elbows centered on maintenance of a functional arc of motion through physical therapy aimed at regaining muscle strength and the use of orthoses for support. Operative treatment was performed for an associated ulnar or radial nerve compression syndrome in three patients, and an open reduction and internal fixation of an unstable proximal ulnar nonunion associated with loose implants 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, the patients in this series demonstrated remarkably good function.


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