History: 40 year old patient with spinal cord injury.
AP radiograph of the right shoulder with internal rotation of the humerus reveals cystic degenerative changes involving the humeral head and acromioclavicular joint. Additionally, the humeral head has an abnormal morphology.
Follow up AP radiograph of the shoulder in the same patient only five months later shows complete destruction of the humeral head with a cut off appearance of the proximal humerus, as well as destruction of the glenoid. The shoulder joint is also distended.
This is a case of neuropathic osteoarthropathy, also known as a Charcot joint. The imaging findings are typically described as the 5 “Ds,” which include normal bone Density, joint Distension, bony Debris, cartilage Destruction, and joint Disorganization (or dislocation/deformity). Usually when seen in the shoulder it is indicative of an entity called syringomyelia, however, in this patient it was spinal cord injury.