Journal of Clinical and Diagnostic Research. 2018 Mar, Vol-12(3): TD01-TD03 1 1 DOI: 10.7860/JCDR/2018/31442.11262 Case Report Radiology Section Neuropathic Shoulder Joint Associated with Syrinx and Chiari Malformation Type I Clinically Masquerading as Malignancy-A Case Report CASE REPORT A 40-year-old male patient, labourer by profession, presented to Orthopaedics department with progressively increasing swelling of the right shoulder joint since one and a half month along with mild dull aching pain. He had no history of fever, trauma, cough, weight loss, discharge, other comorbidity or drug allergy. There was no history of similar illness in the past. No similar family history was present. No history of any spinal cord disease and no systemic symptoms were present. On examination, patient was fairly built with no signs of clubbing, cyanosis, icterus or pallor. On local joint examination, an ill defined soft swelling was present at right shoulder measuring about 6×6 inches and overlying skin was normal. No local rise of temperature was seen. Range of motion was Flexion 0-90°, Abduction 0-90°, internal rotation 0-90° and External rotation 0-10°, Franklin test was negative, abdominal push off and lift up test were positive. Right axillary lymph nodes were palpable. Routine blood tests were normal. Clinically, diagnosis of malignancy was made as primary provisional diagnosis. The patient was referred to the department of Radiodiagnosis for the investigations. Plain radiography of right shoulder joint revealed destruction of entire head of humerus as well as multiple bony fragments surrounding the joint and overlying soft tissue swelling. The bone mineralisation of the uninvolved bones was normal [Table/Fig-1]. Subsequently, Computed Tomography (CT) and MRI were performed. Unenhanced CT and contrast enhanced MRI showed RUCHI GUPTA 1 , KISHORE KUNAL 2 , SUBHASH KUMAR 3 , NEETU SINHA 4 , ABHISHEK ANAND 5 Keywords: Chiari malformation, Chondrosarcoma, Neuropathic joint, Shoulder joint, Syrinx ABSTRACT We report a rare case of 40-years-old male patient who presented with right shoulder joint swelling and reduced range of motion since one and half month. Subsequent X-ray and Magnetic Resonance Imaging (MRI) revealed completely resorbed humeral head, extensive intra-articular debris, joint effusion and thickened synovium. MRI of whole spine showed long segment syrinx, pointed peg of tonsils with tonsillar ectopia and basilar invagination. Diagnosis of atrophic type of Neuropathic shoulder joint secondary to syrinx and Chiari malformation was made. [Table/Fig-1]: X-ray AP view of right shoulder joint a) and Oblique view b) shows complete destruction of humeral head, widening of gleno-humeral joint space, multiple osseous debris (black arrow) and overlying soft tissue swelling. Based on X-ray findings, diagnosis of Neuropathic joint was made. destruction of head of humerus and glenoid fossa with multiple bony debris within the joint cavity and adjacent muscles with markedly thickened and enhancing synovium and joint effusion [Table/Fig-2,3]. [Table/Fig-2]: a) Volume rendered image (VRT) showing amputated articular end of humerus and glenoid fossa and multiple periarticular osseous debris; b) Axial soft tissue image showing bony fragment within the triceps muscle (yellow arrow); c) Coronal reformatted image showing fluid collection with multiple osseous fragments within. Multiple hypointense foci were seen within and surrounding the joint cavity and within triceps muscle on T2 weighted images to suggest bony debris. There was complete involvement with heterogeneous signal of rotator cuff tendons with heterogeneous enhancement of the muscle belly of supraspinatus, infraspinatus, subscapularis, teres minor, triceps and deltoid muscle. Marked fatty degeneration of supraspinatus muscle and mild fatty atrophy of subscapularis and infraspinatus tendon was seen. There was involvement of acromioclavicular joint with cortical irregularity and subchondral cyst