Neurogenic Arthropathy (Charcot Joint)

Key Features

• Joint destruction resulting from loss or diminution of proprioception, pain, and temperature perception

• As normal muscle tone and protective reflexes are lost, secondary degenerative joint disease ensues

• Although initially described in the knees of patients with tabes dorsalis, it is now more frequently seen in association with diabetic neuropathy (foot and ankle) or syringomyelia (shoulder)

Clinical Findings

• An enlarged, boggy, relatively painless joint with extensive cartilage erosion, osteophyte formation, and multiple loose-joint bodies

Diagnosis

• Radiographs can reveal striking osteolysis that mimics osteomyelitis or dramatic destruction of the joint with subluxation, fragmentation of bone, and bony sclerosis

• Differential diagnosis

  • Repeated trauma (causing degenerative joint disease)

  • Rheumatoid arthritis

  • Chronic hemarthrosis (bleed)

  • Chondrocalcinosis (eg, pseudogout, hemochromatosis, Wilson disease)

Treatment

• Directed toward the primary disease

• Mechanical devices are used to assist in weight bearing and prevention of further trauma

• In some instances, amputation becomes unavoidable