Evaluation and management of neuropathic arthropathy of the shoulder: narrative review.

Neuropathic arthropathy of the shoulder, or Charcot shoulder, is a rare and destructive neuroarthropathy resulting from impaired protective sensation and altered joint mechanics that is most commonly associated with syringomyelia. The pathogenesis is believed to involve both neurotraumatic and neurovascular mechanisms, resulting in progressive osseous destruction, joint instability, and soft tissue compromise. Clinical presentation varies, with painless swelling, joint effusion, crepitus, and progressive limitation in shoulder function commonly reported. Radiographic findings frequently demonstrate rapid joint destruction, humeral head collapse, fragmentation, and periarticular bone resorption. Accurate diagnosis requires a thorough clinical assessment combined with imaging and laboratory evaluation to exclude other causes of joint destruction. Advanced imaging is important in identifying associated neurologic abnormalities and early joint changes. Management strategies remain challenging and must be individualized based on symptom severity, functional demands, and the underlying neurologic condition. Non-operative treatment remains the first-line approach for many patients, particularly in early or less symptomatic stages. Surgical management may be considered in cases with severe pain, instability, or significant functional impairment. Although arthrodesis was historically the primary surgical option, advancements in shoulder arthroplasty and tendon transfer techniques have expanded treatment strategies.