Charcot shoulder is a rare, progressive form of joint breakdown that occurs when protective pain and temperature sensation in the shoulder are lost. The condition is most often triggered by syringomyelia (a fluid-filled cavity in the spinal cord) and can lead to rapid joint destruction without prompt treatment.
What is Charcot Shoulder?
Charcot shoulder (also known as neuropathic arthropathy) is a degenerative joint disease resulting from impaired nerve supply. Without normal sensation, the shoulder experiences repeated, unrecognised micro-injuries. Over time, this results in bone loss, dislocation and severe loss of function.
Why does it happen?
- Syringomyelia – the most typical cause, responsible for about 75 % of Charcot shoulder cases
- Diabetes (usually affects feet/ankles but occasionally the shoulder)
- Previous spinal cord injury, Chiari malformation or basilar impression
- Rarely: leprosy, chronic alcoholism or congenital pain insensitivity
Typical Signs & Symptoms
- Painless (or surprisingly mild) swelling and warmth around the shoulder
- Crackling or grinding during movement (crepitus)
- Instability or repeated dislocation
- Gradual loss of lifting strength and range of motion
- Reduced feeling for pain and temperature in a “cape-like” pattern across the arms
If any of these symptoms appear suddenly, seek urgent medical attention to rule out infection.
How is it Diagnosed?
- Clinical examination – looking for joint laxity and altered sensation.
- X-rays – may show fragmentation, bone loss and joint disorganisation.
- MRI of the cervical spine – essential to confirm or exclude a syrinx.
- Blood tests / joint fluid – to exclude infection or inflammatory arthritis.
Treatment Options
- Address the underlying nerve problem
- Neurosurgical decompression of the syrinx or Chiari malformation can halt further damage and occasionally allows bone to remodel.
- Protect the shoulder early
- Temporary sling or brace to reduce further micro-trauma
- Physiotherapy focused on gentle range-of-motion and shoulder-blade control
- Anti-inflammatory tablets for pain and swelling management
- Surgery to the shoulder (select cases)
- Arthrodesis (fusion) in a functional position when pain or instability persist
- Hemi- or reverse total shoulder replacement for carefully selected, stabilised patients who have failed conservative care
Surgery is complex and considered “off-label” because neuropathic bone can loosen implants. Decisions are made on a case-by-case basis by specialist teams.
Living With Charcot Shoulder
- Report any new swelling, redness or fever quickly – infection can mimic Charcot changes.
- Use joint-protective techniques (e.g., avoid heavy lifting, use two hands).
- Maintain overall fitness; aerobic exercise and lower-limb strength help shoulder rehabilitation.
- Access support services; patients’ associations and occupational therapists can advise on adaptations.
Clinical Pearls / Key Points
- Loss of pain does not mean absence of damage – silent destruction is typical.
- Always image the cervical spine when unexplained destructive shoulder arthritis is found.
- Early neurosurgical referral can stabilise the joint and limit disability.
- Distinguish Charcot shoulder from infection; indium-labelled white-cell scans are helpful.
- Shoulder replacement is possible but requires careful patient selection and counselling.
Patient FAQs
What is the difference between Charcot shoulder and frozen shoulder?
Charcot shoulder causes bone and joint destruction due to nerve loss; frozen shoulder relates to tightness of the joint capsule and usually recovers over time.
Will my pain improve after nerve surgery?
Many people notice less pain once spinal pressure is relieved, although some stiffness may remain.
Is physiotherapy safe?
Yes – gentle, guided movements keep the joint mobile and reduce swelling. Heavy resistance exercises are avoided until the condition is stable.
Could both shoulders be affected?
Charcot change usually starts on one side but monitoring the opposite shoulder is sensible, especially if syringomyelia extends across the spinal cord.
When is shoulder replacement considered?
Only after the syrinx is treated and the joint has stopped deteriorating; your surgeon will discuss risks, benefits and realistic goals.
Call to Action
If you have pain, book an appointment to be reviewed by Prof Imam or another member of our specialist team at The Arm Clinic. Early specialist care helps prevent long-term issues. Visit www.TheArmDoc.co.uk or book your consultation today. Phone: 020 3384 5588 | Email: Info@TheArmDoc.co.uk
Disclaimer
This information is for general educational purposes and should not be used as a substitute for professional medical advice. Consult a healthcare professional for individual guidance on your condition and treatment options.
This page was last clinically updated in May 2025