Charcot neuroarthropathy

(redirected from neuropathic osteoarthropathy)

Charcot neuroarthropathy

; Charcot joint disease; neuropathic osteoarthropathy gross distortion of weight-bearing joints secondary to long-term sensory and autonomic neuropathy, abnormal inflammatory and healing responses; early immobilization for a minimum of 12 weeks is essential to minimize joint distortion; typical of diabetes mellitus and tabes dorsalis (syphilis)
  • atrophic Charcot neuroarthopathy; diabetic osteolysis joint destruction characterized by rapid hyperaemic bone resorption (secondary to autonomic neuropathy, abnormal bone blood flow and local periarticular osteopenia) leading to 'pencilling' ('sucked candy stick') of distal metatarsals

  • hypertrophic Charcot neuroarthropathy joint destruction characterized by rapid loss of joint architecture (secondary to pain and proprioception loss and local cortical microfractures) and associated disorganized osseous proliferation (due to abnormal bone-healing response) with resultant foot deformity, often of midtarsal or ankle joints (Table 1and Table 2)

Table 1: Classification of Charcot neuroarthropathy
StageCharacteristics
0Clinical symptoms only: erythema, oedema, increased temperature (>2°c difference)
IDevelopmental: generalized bone demineralization, periarticular fragmentation, loose-body formation, joint dislocation
IICoalescent: organization and healing of fracture fragments, periosteal new bone formation, resorption of bone debris
IIIReconstruction/consolidation: greater definition of bone contours, reconstruction or ankylosis of involved bone
Table 2: Clinical features of hypertrophic Charcot joint disease
VascularNeuropathicSkeletalCutaneous sequelae
Bounding pulses
Erythema
Oedema
Warmth
Lost or reduced: Pain/vibration awareness
Proprioception
Deep tendon reflexes
'Rocker bottom' foot
Midfoot subluxation
Digital contracture
Hypermobility
Hyperkeratosis
Trophic ulceration
Secondary infection
References in periodicals archive ?
Moreover, it may occur in the setting of preexistent osteoarthritis, rheumatoid arthritis, osteonecrosis, osteochondritis dissecans, neuropathic osteoarthropathy, tuberculosis, or osteochondral fractures.
It illustrates the analysis of radiographic changes in a specific joint and the common arthropathies that produce these changes, then the radiographic hallmarks of each, with chapters on rheumatoid arthritis, psoriatic and reactive arthritis, ankylosing spondylitis, osteoarthritis, neuropathic osteoarthropathy, diffuse idiopathic skeletal hyperostosis, gout, calcium pyrophosphate dihydrate crystal deposition disease, hydroxyapatite deposition disease, miscellaneous deposition diseases, collagen vascular diseases, juvenile idiopathic arthritis, hemophilia, and mass-like arthropathies.
The differential diagnosis includes other causes of osteomyelitis, including fungal or parasitic etiologies, neuropathic osteoarthropathy, and neoplasm.
Coverage includes the functional anatomy of the knee joint, traumatic disorders, degenerative diseases, inflammatory diseases, tumors and tumorlike lesions, endocrine/metabolic disorders and crystal-induced diseases, ischemic diseases, hematologic diseases, neuropathic osteoarthropathy, and pediatric radiology.
Charcot arthropathy (also known as neuropathic osteoarthropathy or neuropathic arthropathy) is a progressive, degenerative arthritis associated with an underlying central or associated neurological disease that affects the peripheral or spinal joints (1) It was first reported in 1868 by Charcot in a case (1) that involved tabes dorsalis and is especially characterized by progressive osteoclasts, bone resorption, and deformity.