A “Joint-First” Multidisciplinary Team Strategy for Charcot Shoulder Secondary to Syringomyelia: A Case Report on the Rationale for Staged Surgical Management

Background: Charcot shoulder secondary to syringomyelia (CSSS) is an extremely rare and devastating neuro-orthopedic complication, with only a handful of cases reported worldwide. The optimal surgical timing (orthopedic vs. neurosurgical) and choice of implants remain controversial, posing a major clinical challenge. Case presentation: We report the case of a 50-year-old woman presenting with end-stage CSSS. Imaging confirmed the presence of a cervicothoracic syrinx associated with Chiari type I malformation. After comprehensive deliberation by a multidisciplinary team (MDT), we adopted an innovative “joint-first” staged management strategy. The patient first underwent humeral head replacement to stabilize the shoulder, relieve disabling pain, and halt progressive bone loss, with neurosurgical decompression planned for a later stage. Her Constant-Murley score improved from 25 preoperatively to 80 one month postoperatively, indicating marked functional recovery. Conclusion: This case highlights the decision-making process and rationale behind a patient-centered, MDT-driven individualized treatment strategy in a context of significant clinical uncertainty. We propose that, in selected patients with end-stage CSSS, prioritizing joint pathology may represent a reasonable and effective option. Such an approach not only provides substantial early functional benefits but also establishes a stable physiological foundation for subsequent neurosurgical intervention.