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For further information, see CMDT Part 22-48: 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 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

  • Surgical strategies, including arthrodesis, with or without orthobiologics, can be considered if nonsurgical management fails

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