NEUROPATHIC JOINT ELBOW SYRINX SYRINGOMYELIA SPINE MRI

• Right handed 60 yo lady presented with left elbow swelling and mild pain. No movement restriction.
  

• No other joints involved.

• Negative for inflammatory arthropathy workup.

Image above: Multiple loose bodies and effusion. No joint destruction. No chondrocalcinosis.

Image above: Effusion(Pink arrow) Extensive full thickness cartilage loss (Green arrows) Subcortical geode (Orange arrow) and Extensive generalized bone marrow oedema (Blue arrows).

RADIOLOGICAL INTERPRETATION:

The imaging findings are those of a severe degenerative changes with multiple loose bodies. An unusual finding for OA was the extensive generalised bone marrow oedema.

WHAT WAS THE CLINICAL INTERPRETATION OF THE IMAGING FINDINGS

1. Imaging suggests extensive degeneration but the elbow is an uncommon joint for primary OA. Additionally the patient is right handed and this is the left elbow involved.

2. Based on degenerative appearing changes in the elbow, an unusual joint for primary OA, the main clinical differential considered by Dr Thomas was either Neuropathic arthropathy or CPPD.

3. CPPD was thought unlikely bases on the lack of a typical appearance and absence of any other areas of involvement. 

So a Cervical MRI was performed.

Image above: Benign syrinx cervical cord (Pink arrows) larger to left side.

The patient was also seen by a Neurologist and based on the combination of Imaging and Clinical findings, a Neuropathic arthropathy due to a syrinx was diagnosed.