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 OJIM  Vol.2 No.1 , March 2012
Neuropathic arthropathy of the shoulder: Two cases of syringomyelia with cocaine use
Abstract: Neuropathic arthropathy (NA) is a progressive, degenerative disorder associated with decreased sensory innervation of the involved joints. The shoulder joint is an uncommon presentation for NA, although syringomyelia is the most common cause for this joint. Two cases are presented of NA of the shoulder, with both patients having a history of syringomyelia and cocaine use. In both cases a work up for malignancy was negative, but imaging was consistent with NA. Although syringomyelia has been linked with this presentation in prior publications, the role of cocaine use may not be incidental, with complex biochemical interactions in bone metabolism. Cocaine has been shown to involve the Leptin, Neuromedin U (NmU), cocaine and amphetamine-regulated transcript (CART), and Receptor activator of nuclear factor kappa-B ligand (RANKL) pathways of bone remodeling. Treatment can be challenging, involving concurrent use of pharmacotherapy, surgical correction, and protective bracing.
Cite this paper: Rubano, J. , Bhana, S. , Modjinou, D. , Pameijer, C. and Roppelt, H. (2012) Neuropathic arthropathy of the shoulder: Two cases of syringomyelia with cocaine use. Open Journal of Internal Medicine, 2, 27-30. doi: 10.4236/ojim.2012.21006.
References

[1]   Nacir, B. and Cebeci, S.A. (2009) Neuropathic arthropathy progressing with multiple joint involvement in the upper extremity due to syringomyelia and type I arnold chiari malformation. Rheumatology International, 30, 979-983. doi:10.1007/s00296-009-1013-5

[2]   Brower, A.C. and Allman R.M. (1981) Pathogenesis of the neurotrophic joint: Neurotraumatic vs. neurovascular. Radiology, 139, 349-354.

[3]   Weissman, B.N. and Firestein (2008) Kelley’s textbook of rheumatology. 8th Edition, W. B. Saunders Company, New York.

[4]   Frykberg, R.G. and Belczyk, R. (2008). Epidemiology of the charcot foot. Clinics in Podiatric Medicine and Surgery, 25, 17-28. doi:10.1016/j.cpm.2007.10.001

[5]   Hatzis, N. and Karr, K. (1998) Neuropathic arthropathy of the shoulder. Journal of Bone and Joint Surgery, 80, 1314-1319.

[6]   Lange, R. and Cigorra, R. (1989). Cocaine-induced coronary-artery vasoconstriction. The New England Journal of Medicine, 321, 1557-1562. doi:10.1056/NEJM198912073212301

[7]   Takeda, S. (2008) Genomic approaches to bone and joint diseases. Control of bone remodeling by hormones and neuronal pathways. Clinical Calcium, 18, 216-221.

[8]   Brighton, P.J. and Szekeres, P.G. (2004) Signaling and ligand binding by recombinant neuromedin U receptors: evidence for dual coupling to Galphaq/11 and Galphai and an irreversible ligand-receptor interaction. Molecular Pharmacology, 66, 1544-1556. doi:10.1124/mol.104.002337

[9]   Sato, S. and Hanada, R. (2007) Central control of bone remodeling by neuromedin U. Nature Medicine, 13, 1234-1240. doi:10.1038/nm1640

[10]   Cirmanová, V., Bayer, M., Stárka, L. and Zajícková, K. (2008) The effect of leptin on bone: An evolving concept of action. Physiological Research, 57, S143-S151.

[11]   Ruette, P. and Stuyck, J. (2007) Neuropathic arthropathy of the shoulder and elbow associated with syringomyelia: A report of 3 cases. Acta Orthopaedica Belgica, 73, 525-529

[12]   Garg, R.K. and Kar, A.M. (2008) Charcot shoulder in syringomyelia. Internal Medicine Journal, 38, 868-870. doi:10.1111/j.1445-5994.2008.01784.x

 
 
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