This study provides a 1-3 year follow-up of five patients with neuropathic arthropathy of the elbow. The underlying conditions included syringomyelia, diabetes mellitus, renal failure, and polyneuropathy. Physical characteristics included a swollen, erythematous and unstable joint with painless crepitus. Characteristic radiographic findings included elbow dislocation, fracture fragmentation, and heterotropic ossification. Operative intervention was directed at stabilizing non-unions and decompressing ulnar or radial nerve compressive neuropathies. All patients underwent formal physical therapy aimed at maximizing range of motion and motor strength. Orthoses were provided as needed for support. At a minimum of 12 months follow-up, all patients had a pain free elbow with a flexion-extension arc between 900-1250. The 3 patients treated surgically for a compression neuropathy recovered nerve function.
Although few articles focus on neuropathic arthropathy of the elbow, classic teaching related to the treatment of Charcot joints (in the lower extremity) involves immobilization until acute inflammation has resolved. These authors suggest focusing on restoration of motion with immediate therapy. They suggest that the lower forces imparted to the elbow allow the process to stabilize while maintaining joint motion. Operative intervention is recommended for stabilization of associated non-unions and significant peripheral neuropathies. Although there is short follow-up, the overall outcome is quite reasonable.