Charcot joint or neuropathic joint are destructed joint occurs in Diabetes, syphilis, syringomyelia , leprosy, AMLS, Peripheral neuropathy and any condition leads to impair sensation of peripheral part of body
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
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
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