Q: My son experienced shoulder disintegration. This was a surprise to us because he did not have pain. He was diagnosed with a neurogenic joint. Is there such a condition? What are the chances that he will experience this in another joint?

A:

Neurogenic (aka neuropathic) joints are associated with conditions where sensation is diminished. These joints can be a result of absent or diminished sensation associated with Spina Bifida, particularly when there is also a Chiari malformation or syrinx (cyst) in the spinal cord. Muscle weakness around the joint also contributes by making the joint less stable and subject to frequent trauma which is what causes damage to the bones. Shoulders are often affected when an individual with Spina Bifida relies on the upper extremities to assist in propulsion (either with the wheelchair or from using forearm crutches). As the shoulder was not designed for such a work-load, it can be damaged from overuse and load stress.

Other joints that can be involved are the hips, knees, and ankles. The lower extremities are more at risk for someone who is ambulatory compared to someone who uses a wheelchair for mobility. Using properly fitting braces and crutches can decrease stress loads on the lower extremity joints. Using a wheelchair for longer distances can also help the lower joints, but will increase stress on the shoulders. Using propulsion assistance (power-assist or electric chairs or scooters) can alleviate some of the stress on the shoulders.

I recommend talking with your musculoskeletal team (orthopedist, physiatrist, physical therapist, and/or orthotist) about how to minimize the stress on your joints.

* This information does not constitute medical advice for any individual. As specific cases may vary from the general information presented here, SBA advises readers to consult a qualified medical or other professional on an individual basis.