Background: Neuropathic arthropathy of the elbow
is rare and characterized by a painless but unstable articulation.
The functional capacity of patients with this condition has not
been reviewed in detail.
Methods: Five male patients, with an average age
of fifty-one years, were treated for neuropathic arthropathy of the
elbow. The underlying conditions associated with the arthropathy
included syringomyelia, insulin-dependent diabetes mellitus, end-stage
renal failure, and two cases of polyneuropathy of unknown cause.
Four patients sought medical attention after a specific traumatic
event. Peripheral sensory and motor dysfunction was present in each patient.
Radiographs of the elbow revealed dislocation, fracture fragmentation,
and heterotopic ossification. Our management of the neuropathic
elbows centered on maintenance of a functional arc of motion through
physical therapy aimed at regaining muscle strength and the use
of orthoses for support. Operative treatment was performed for an
associated ulnar or radial nerve compression syndrome in three patients,
and an open reduction and internal fixation of an unstable proximal
ulnar nonunion associated with loose implants was performed in one.
Results: The patients were followed for an average
of nineteen months, with a range of twelve to thirty-six months.
All patients had a pain-free elbow with a functional range of motion
at the most recent follow-up examination, and none wished to have
further treatment. The operatively treated ulnar nonunion united
successfully. All three patients treated surgically for an associated
nerve compression syndrome had recovery of nerve function.
Conclusion: In the face of instability and gross
distortion of the joint, the patients in this series demonstrated remarkably