[Imaging assessment and treatment of Charcot arthropathy of the shoulder assisted by NGH classification]

Charcot arthropathy of the shoulder is a rare destructive joint disorder that is most commonly secondary to syringomyelia and often leads to osteolysis of the shoulder joint and severe upper limb dysfunction. The diagnostic and therapeutic challenges of this condition lie not merely in identifying joint destruction, but in the nonspecific nature of its early clinical manifestations, which may mimic infection, tumor, or inflammatory arthropathy. In addition, the extent of bone destruction in the glenoid and humeral head may vary considerably, making conventional imaging descriptions insufficient for preoperative assessment and treatment decision-making. The neuropathic gleno-humeral degeneration (NGH) classification independently evaluates the degenerative changes of the glenoid and humeral head on imaging. This classification helps reduce ambiguity in radiographic descriptions and provides a reference for clinical surgical decision-making. Current evidence suggests that the management of Charcot arthropathy of the shoulder should be based on comprehensive assessment: Radiography may be used for initial diagnosis with assistance from the NGH classification; magnetic resonance imaging can evaluate soft tissue conditions and related abnormalities; and computed tomography with three-dimensional reconstruction is useful for quantifying bone defects and planning prosthetic implantation. In patients with swelling, joint effusion, elevated inflammatory markers, or planned surgery, joint aspiration and biopsy should be considered to exclude infection, tumor, and inflammatory joint diseases. For patients whose joint destruction has entered a quiescent phase, shoulder arthroplasty and other surgical procedures may be considered. In the future, multi-center and prospective cohort studies, and long-term follow-up are still needed to further validate the clinical value of NGH classification and clarify the long-term efficacy of shoulder replacement surgery.