Charcot joint disease, first described by Jean-Martin Charcot in 1868, is a progressive joint condition often misdiagnosed, primarily affecting the lower limbs and linked to neuropathy, especially from diabetes. Imaging techniques like X-rays and MRI are critical for diagnosis, distinguishing it from conditions like osteomyelitis, which shows different scan results. Treatment includes rest and immobilization, with surgical options available in non-inflammatory stages.

2.  In 1868, Jean-Martin Charcot gave the first detailed
description of the neuropathic aspect of this disease;
hence, the condition is named after him.
 Progressive destructive disease of joint.
 Painless arthropathy with dislocation, fracture,
debilited deformities.
 Frequently misdiagnosed.

3.  Most commonly involve joints of lower limb.
 Any condition that causes sensory or autonomic
neuropathy can lead to a Charcot joint
 Diabetes is considered to be the most common cause
of Charcot arthropathy.
 Prevalence is 0.5%.
 Bilateral disease in < 10%

4. NEUROTRAUMATIC THEORY;
An unperceived trauma or injury to an insensate
joint.
NEUROVASCULAR THEORY:
autonomic neuropathy increase vascularity
mismatch in destruction & synthesis

5.  Genetics molecular biology
 RANK/RANKL/OPG triad pathway is thought to be
involved

6.  Associated conditions shoulder
 syringomyelia
 most common etiology of neuropathic arthropathy of the
upper extremity
 25% of these patients develop a neuropathic joint
 Mono articular (shoulder > elbow)
 Hansen's disease (leprosy)
 second most common cause of upper extremity neuropathic
arthropathy

7.  syphilis
 usually affects the knee
 can be poly articular
 diabetes
 most common cause of foot and ankle neuropathic joints
 Arnold- Chiari malformation
 cervical spondylosis
 adhesive arachnoiditis and TB arachnoiditis
 posttraumatic syringomyelia
 alcoholism

8.  AP radiography
shows fragmentation
and joint destruction.

9.  AP radiograph shows
joint destruction and
dislocation.

10. Elbow
 syringomyelia
 syphilis
 congenital insensitivity to pain
 diabetes
 Charcot-Marie-Tooth

11.  AP radiograph shows
joint destruction and
heterotrophic
ossificans.

12.  X rays showing joint
destruction and
dislocation

13.  X rays shows joint
destruction and new
bone formation

14.  Classification Eichenholtz Classification
 Stage 0 • Joint edema
• Radiographs are negative
• Bone scan may be positive in all stages
Stage 1 • Joint edema
• Radiographs show osseous fragmentation with joint
dislocation
Stage 2 • Decreased local edema
• Radiographs show coalescence of fragments and
absorption of fine bone debris
Stage 3 • No local edema
• Radiographs show consolidation and remodeling of
fracture fragments

15.  Stage 0
 Hot foot
 X rays normal
 MRI shows marrow
edema and micro
fractures

16.  Stage 1
(Hydrarthrosis)
 Fragmentation
 Bone resorption
 Fracture
 dislocation

17.  Stage 2 ( Atrophy)
 Coalescence
 Sclerosis
 Fracture healing
 Debris resorption

18.  Stage 3
( Hypertrophy)
 Remodeling

19.  Presentation Symptoms
 swollen shoulder or elbow
 50% have pain, 50% are painless
 loss of function
 Physical exam
 inspection
 swollen, warm, erythematous joint
 mimics infection
 motion
 joint may be mechanically unstable
 loss of active motion, but passive motion is maintained
 neurovascular
 a neurologic evaluation is essential

20.  Imaging Radiographs
 recommended views
 standard views of affected joint
 AP and scapula Y of the shoulder
 AP and lateral of the elbow
 AP and lateral of foot and ankle
 findings
 early changes
 degenerative changes may mimic osteoarthritis
 late changes
 obliteration of joint space
 fragmentation of both articular surfaces of a joint leading
to subluxation or dislocation
 scattered "chunks" of bone in fibrous tissue
 joint distention by fluid
 surrounding soft tissue edema
 heterotopic ossification
 fracture

21.  MRI
 indications
 MRI of cervical spine to rule out syrinx when neuropathic
shoulder arthropathy is present
 Bone scan
 technetium bone scan
 findings
 may be positive (hot) for neuropathic joints and osteomyelitis
 indium WBC scan
 findings
 will be negative (cold) for neuropathic joints and positive (hot) for
osteomyelitis
 useful to differentiate from osteomyelitis

22.  Studies Labs
 ESR and WBC can be elevated making it difficult to
differentiate from osteomyelitis
 Histology
 synovial hypertrophy
 detritic synovitis (cartilage and bone distributed in
synovium)

23.  Differential diagnosis :
 Osteomyelitis/septic joint
 difficult to distinguish from osteomyelitis based on
radiographs and physical exam
 common findings in both conditions
 swelling, warmth
 elevated WBC and ESR
 technetium bone scan is "hot"
 unique to Charcot joint disease
 indium leukocyte scan will be "cold" (negative)
 will be "hot" (positive) for osteomyelitis

24.  Treatment
 Non operative
 rest, elevation, protected immobilization with a sling, and
restriction of activity
 indications
 neuropathic shoulder joint
 functional bracing
 indications
 neuropathic elbow joint
 technique
 should allow flexion-extension, but neutralizes varus-valgus
stresses

25.  Operative
 Arthrodesis
 do not attempt during acute inflammatory stage (Eichenholtz
0-2) because of continued bone erosion
 only perform during quiescent stage (Eichenholtz 3)
 requires long periods of immobilization
 Total joint replacement
 indications
 Charcot joint is a contraindication to total joint replacement
 due to poor bone stock, prosthetic loosening, instability, and soft-
tissue compromise

26. An ounce of prevention is worth a pound of
cure.”
– Benjamin Franklin