# A Case Report of Neuropathic Arthropathy in Chronic Syrinx Raising Suspicion of Malignancy

## TL;DR

This case report highlights a rare instance of shoulder neuropathic arthropathy caused by a long-standing syrinx, initially suspected to be a tumor.

## Contribution

The paper presents a unique case linking chronic syrinx to shoulder arthropathy, emphasizing diagnostic challenges and multidisciplinary management.

## Key findings

- A longstanding syrinx can present as a fluid-filled mass mimicking malignancy.
- Thorough clinical and imaging evaluation is essential to differentiate NA from tumors.
- Multidisciplinary management is crucial for optimal outcomes in such complex cases.

## Abstract

Syringomyelia is a prevalent cause of Charcot arthropathy, notably affecting the elbow and less frequently the shoulder. Before attributing neuropathic arthropathy (NA) to a syrinx, careful investigation of various potential causes is vital. We present a unique case of NA affecting the left shoulder, secondary to a longstanding syrinx presenting as an expansile mass on imaging, raising suspicion of malignancy. The patient presented with progressive left arm swelling, limited mobility, and a history of chronic left shoulder pain. Through clinical evaluation and imaging, including X-rays and CT scans, significant bone destruction and a large fluid-filled mass in the left shoulder were observed. Laboratory tests ruled out other potential diagnoses, and a bone biopsy excluded malignancy. This study emphasizes the importance of thorough differential diagnosis and appropriate imaging techniques to distinguish NA from other conditions. The diagnosis of NA relies on a comprehensive assessment involving clinical signs, symptoms, radiological imaging, and additional tests aimed at excluding other potential causes, including soft tissue tumors. Management strategies, including conservative approaches and surgical interventions like neurosurgical decompression and shoulder arthroplasty, are discussed. The study sheds light on the challenges in diagnosing and managing NA associated with syringomyelia and emphasizes the significance of a multidisciplinary approach for optimal outcomes.