A 66-year-old woman complained of chronic, non-traumatic right shoulder pain and function loss. She presented with cervical pain, but no neurological symptoms. Radiography (Figure 1; A) and MRI (Figure 1; B, C, D) showed severe degeneration of the glenohumeral joint. Spine MRI (Figure 1; E, F) revealed a C3-T10 syringomyelia and dubious cerebellar tonsillar ectopia. Neuropathic arthropathy (first described in the 19th century as Charcot joint) can be seen in diabetic neuropathy, spinal cord injury, tabes dorsalis, congenital insensitivity to pain and syringomyelia, among other diagnosis. ^{Reference Rickert, Cannon and Kirkpatrick1} Physicians should not overlook shoulder pain, a common complaint in syringomyelia, and, conversely, should remain mindful of the plausible relationship between arthropathy and neurological dysfunction. Our patient declined surgical treatment and is undergoing conservative management and follow-up.

Figure 1.

(A–D) Radiological studies revealing severe degeneration of the glenohumeral joint, primarily at the level of the proximal humerus. (A) Shoulder radiograph shows anteroinferior glenohumeral dislocation, deformity and erosion of the humeral head, and joint surface destruction. Shoulder MRI T2 SPIR (B,C) and T2 FFE (D) demonstrate glenoid deformity with flattening of the anteroinferior margin, bone marrow oedema in the humeral head and the glenoid, intra-articular glenohumeral fluid with communication to the subdeltoid bursa and the acromioclavicular joint and rotator cuff tear with muscular atrophy and oedema. A spine MRI T2 (E) and STIR (F) reveal a C3-T10 syringomyelia (arrows), and dubious cerebellar tonsillar ectopia.