BACKGROUND Charcot neuroarthropathy(CN)is a systemic disease characterized by progressive bone loss and destruction,which is usually closely related to diabetes,HIV,etc.However,CN caused by syringomyelia accounts for ...BACKGROUND Charcot neuroarthropathy(CN)is a systemic disease characterized by progressive bone loss and destruction,which is usually closely related to diabetes,HIV,etc.However,CN caused by syringomyelia accounts for only 5%of CN cases;the shoulder and elbow are most often involved,and the hip joint is rarely affected.As a rare factor,cervical spondylotic myelopathy(CSM)can be associated with syringomyelia,which is scarcely reported in the literature.Here,we present the first case report to date of CN of the hip caused by syringomyelia secondary to CSM.CASE SUMMARY We describe a 76-year-old male patient who was diagnosed with CSM due to neck pain and weakness of limbs 16 years ago.Four years ago,he noticed recurrent swelling of the right hip with pain and was diagnosed with degenerative arthritis.Recently,however,his symptoms gradually worsened,and because of progressive pain,destabilization and weakness of the right hip,he was admitted to our hospital.Through systematic physical,radiographic and laboratory examinations,we finally reached a diagnosis:CN of the right hip associated with syringomyelia secondary to CSM.After comprehensive evaluation of the patient's condition,we performed right total hip arthroplasty.During the follow-up,the patient felt well clinically and could walk independently with a knee brace.CONCLUSION We suggest a possible etiological association between CSM and syringomyelia,which may reflect a potential pathogenesis of CN.We encourage clinicians to actively carry out a detailed medical history and comprehensive physical and imaging examinations in patients with joint lesions,especially chronic shoulder neck pain,to rule out the possibility of this association,which plays a crucial role in the early diagnosis of CN.Arthroplasty may no longer be an absolute contraindication to surgical treatment of CN.Reasonable selection of the surgical strategy can markedly improve the clinical symptoms and quality of life of patients.展开更多
Diabetes mellitus is the most common cause of Charcot neuropathy affecting foot and ankle. Acute Charcot foot(CF) presents with a red and swollen foot in co-ntrast to the painless deformed one of chronic CF. En-hanced...Diabetes mellitus is the most common cause of Charcot neuropathy affecting foot and ankle. Acute Charcot foot(CF) presents with a red and swollen foot in co-ntrast to the painless deformed one of chronic CF. En-hanced osteoclastogenesis plays a central role in the pathogenesis of acute CF. Many studies have shown elevated levels of bone turnover markers in patients with acute CF confirming it. These findings have led cl-inicians to use anti-resorptive agents [bisphosphonates(BP), calcitonin, and denosumab] along with immobi-lization and offloading in acute CF patients. The ma-ximum evidence among all anti-resorptive agents is available for BPs, although its quality is low. Pamidronate has been shown to reduce the markers of activity of CF like raised skin temperature, pain, edema, and bone turnover markers in the majority of studies. Intravenous BPs are known to cause acute phase reactions leading to flu-like illness following their first infusion, which can be ameliorated by oral acetaminophen. Alendronate is the only oral BP used in these patients. It needs to be taken on an empty stomach with a full glass of water to avoid esophagitis. The side-effects and contraindications to BPs should be kept in mind while treating acute CF patients with them.展开更多
The diabetic foot is characterised by painless foot ulceration and/or arthropathy;it is a typical complication of painless diabetic neuropathy.Neuropathy depletes the foot skin of intraepidermal nerve fibre endings of...The diabetic foot is characterised by painless foot ulceration and/or arthropathy;it is a typical complication of painless diabetic neuropathy.Neuropathy depletes the foot skin of intraepidermal nerve fibre endings of the afferent A-delta and C-fibres,which are mostly nociceptors and excitable by noxious stimuli only.However,some of them are cold or warm receptors whose functions in diabetic neuropathy have frequently been reported.Hence,it is well established by quantitative sensory testing that thermal detection thresholds at the foot skin increase during the course of painless diabetic neuropathy.Pain perception(nociception),by contrast,has rarely been studied.Recent pilot studies of pinprick pain at plantar digital skinfolds showed that the perception threshold was always above the upper limit of measurement of 512 m N(equivalent to 51.2 g) at the diabetic foot.However,deep pressure pain perception threshold at musculus abductor hallucis was beyond 1400 k Pa(equivalent to 14 kg;limit of measurement) only in every fifth case.These discrepancies of pain perception between forefoot and hindfoot,and between skin and muscle,demand further study.Measuring nociception at the feet in diabetes opens promising clinical perspectives.A critical nociception threshold may be quantified(probably corresponding to a critical number of intraepidermal nerve fibre endings),beyond which the individual risk of a diabetic foot rises appreciably.Staging of diabetic neuropathy according to nociception thresholds at the feet is highly desirable as guidance to an individualised injury prevention strategy.展开更多
文摘BACKGROUND Charcot neuroarthropathy(CN)is a systemic disease characterized by progressive bone loss and destruction,which is usually closely related to diabetes,HIV,etc.However,CN caused by syringomyelia accounts for only 5%of CN cases;the shoulder and elbow are most often involved,and the hip joint is rarely affected.As a rare factor,cervical spondylotic myelopathy(CSM)can be associated with syringomyelia,which is scarcely reported in the literature.Here,we present the first case report to date of CN of the hip caused by syringomyelia secondary to CSM.CASE SUMMARY We describe a 76-year-old male patient who was diagnosed with CSM due to neck pain and weakness of limbs 16 years ago.Four years ago,he noticed recurrent swelling of the right hip with pain and was diagnosed with degenerative arthritis.Recently,however,his symptoms gradually worsened,and because of progressive pain,destabilization and weakness of the right hip,he was admitted to our hospital.Through systematic physical,radiographic and laboratory examinations,we finally reached a diagnosis:CN of the right hip associated with syringomyelia secondary to CSM.After comprehensive evaluation of the patient's condition,we performed right total hip arthroplasty.During the follow-up,the patient felt well clinically and could walk independently with a knee brace.CONCLUSION We suggest a possible etiological association between CSM and syringomyelia,which may reflect a potential pathogenesis of CN.We encourage clinicians to actively carry out a detailed medical history and comprehensive physical and imaging examinations in patients with joint lesions,especially chronic shoulder neck pain,to rule out the possibility of this association,which plays a crucial role in the early diagnosis of CN.Arthroplasty may no longer be an absolute contraindication to surgical treatment of CN.Reasonable selection of the surgical strategy can markedly improve the clinical symptoms and quality of life of patients.
文摘Diabetes mellitus is the most common cause of Charcot neuropathy affecting foot and ankle. Acute Charcot foot(CF) presents with a red and swollen foot in co-ntrast to the painless deformed one of chronic CF. En-hanced osteoclastogenesis plays a central role in the pathogenesis of acute CF. Many studies have shown elevated levels of bone turnover markers in patients with acute CF confirming it. These findings have led cl-inicians to use anti-resorptive agents [bisphosphonates(BP), calcitonin, and denosumab] along with immobi-lization and offloading in acute CF patients. The ma-ximum evidence among all anti-resorptive agents is available for BPs, although its quality is low. Pamidronate has been shown to reduce the markers of activity of CF like raised skin temperature, pain, edema, and bone turnover markers in the majority of studies. Intravenous BPs are known to cause acute phase reactions leading to flu-like illness following their first infusion, which can be ameliorated by oral acetaminophen. Alendronate is the only oral BP used in these patients. It needs to be taken on an empty stomach with a full glass of water to avoid esophagitis. The side-effects and contraindications to BPs should be kept in mind while treating acute CF patients with them.
文摘The diabetic foot is characterised by painless foot ulceration and/or arthropathy;it is a typical complication of painless diabetic neuropathy.Neuropathy depletes the foot skin of intraepidermal nerve fibre endings of the afferent A-delta and C-fibres,which are mostly nociceptors and excitable by noxious stimuli only.However,some of them are cold or warm receptors whose functions in diabetic neuropathy have frequently been reported.Hence,it is well established by quantitative sensory testing that thermal detection thresholds at the foot skin increase during the course of painless diabetic neuropathy.Pain perception(nociception),by contrast,has rarely been studied.Recent pilot studies of pinprick pain at plantar digital skinfolds showed that the perception threshold was always above the upper limit of measurement of 512 m N(equivalent to 51.2 g) at the diabetic foot.However,deep pressure pain perception threshold at musculus abductor hallucis was beyond 1400 k Pa(equivalent to 14 kg;limit of measurement) only in every fifth case.These discrepancies of pain perception between forefoot and hindfoot,and between skin and muscle,demand further study.Measuring nociception at the feet in diabetes opens promising clinical perspectives.A critical nociception threshold may be quantified(probably corresponding to a critical number of intraepidermal nerve fibre endings),beyond which the individual risk of a diabetic foot rises appreciably.Staging of diabetic neuropathy according to nociception thresholds at the feet is highly desirable as guidance to an individualised injury prevention strategy.
