Neurogenic arthropathy, also known as Charcot joints, is a rare but severely debilitating disorder of the articular system. Diabetic neuropathy, syringomyelia, trauma, neurosyphilis, and many other diseases can induce this phenomenon. Severe neuropathy and vascular insufficiency lead to a rapidly progressive destruction of the joints with symptoms of swelling and erythema and only mild pain. The diagnosis rests on a detailed patient history, a thorough physical examination, and appropriate imaging studies that determine the underlying cause.
Neurogenic arthropathy, initially named as Charcot neuropathic osteoarthropathy, affects the joints and the skeletal system and possesses a chronic and progressive clinical course    . The pathogenesis stems from a diminished function of the sensory nerves arising due to significant peripheral neuropathy, which may be encountered in various conditions    . By far, the most common etiology is diabetic neuropathy, affecting up to 13% of cases suffering from severe forms of this ailment . Other notable causative factors are syringomyelia, neurosyphilis, trauma to the spinal or peripheral nerves, and several other conditions affecting the nervous system   . Virtually any joint can be affected by neurogenic arthropathy. Some studies have established that neurosyphilis present in the knee, whereas the foot and ankle are mainly targeted in diabetic patients  . The clinical presentation is distinguished by a somewhat rapid onset of erythema and swelling of the joint with minimal or mild accompanying pain, which is one of the reasons why patients present very late to the physician . A limited range of motion and stiffness is frequently observed, particularly in the shoulder joint . In addition to localized joint symptoms, autonomic dysfunction may be simultaneously present with complaints of constipation, urinary retention, erectile dysfunction, and arrhythmias  .
Entire Body System
The finding of considerable amounts of cartilaginous and osseous debris within the synovial membrane (termed detritic synovitis) should alert the pathologist that the changes may represent a neuropathic joint. [emedicine.com]
The eminent French pathologist and neurologist, Jean-Martin Charcot, was also there and gave a presentation on tabetic disease of the bones and joints. [doi.org]
- Swollen Knee
It is seen in up to 9% of patients with diabetic neuropathy.  Similar pathology can also occur in the knee but is much less common and should be considered in a patient with peripheral neuropathy, who presents with a red, hot, tender, and swollen knee [emedicine.com]
Description A progressive destructive arthritis secondary to peripheral neuropathy and the associated loss of pain sensation. [unboundmedicine.com]
People rarely develop a second arthritis that is caused by bacteria (see Infectious Arthritis ) and may or may not have the fever or general feeling of illness (malaise) that typically occurs with infectious arthritis. [merckmanuals.com]
The patient was subsequently taken to theatre for washout and debridement of the right elbow for a suspected septic arthritis. [nzma.org.nz]
Differential diagnosis includes tumor and septic arthritis. We report a case of neurogenic hip arthropathy in a 30-year-old diabetic woman, and illustrate the clinical history and imaging findings. [link.springer.com]
- Joint Dislocation
Stage 1: Osseous fragmentation with joint dislocation seen on radiograph ("acute Charcot"). [en.wikipedia.org]
Ligamentous laxity, muscular hypotonia, and rapid destruction of joint cartilage are common, predisposing to joint dislocations, which also accelerate disease progression. [merckmanuals.com]
Neuropathic arthropathy is a progressive musculoskeletal disease that is evidenced by deformities, joint dislocation and fractures. This results in progressive destruction of bone and soft tissue of your weight-bearing joints. [disabilitycasereview.com]
Stage 1 : Osseous fragmentation with joint dislocation seen on radiograph ("acute Charcot"). [uwmsk.org]
The foot or ankle displays permanent enlargement and fixed deformity due to the bone fragments and joint dislocation healing in a displaced position. The skin color and temperature gradually normalize. [amputee-coalition.org]
- Joint Effusion
Imaging Radiography indication for all patients findings can be normal in early Charcot joint acute bony consolidation with fractures, joint effusion, or bone destruction chronic bony deformity, new bone formation, and sclerosis resorption of bone Magnetic [medbullets.com]
Joint effusion, calcification within the joint capsule, loose bodies and increased density within the distal humerus, proximal radius and ulnar are evident. [nzma.org.nz]
Progressive joint effusion, fracture, fragmentation, and subluxation should raise the suspicion of neuroarthropathy. [emedicine.com]
Hemorrhagic joint effusions and multiple small fractures can occur, accelerating disease progression. [merckmanuals.com]
- Joint Swelling
Swelling Diagnostic tests X-rays confirm the diagnosis and allow evaluation of damage. [medical-clinic.org]
Common manifestations include joint swelling, effusion, deformity, and instability. Pain may be disproportionately mild due to the underlying neuropathy. Diagnosis requires x-ray confirmation. [merckmanuals.com]
[…] a neutrally medicated persistent hyperaemia. 1,7 A further theory proposes that joint changes result from damage to central nervous system ‘trophic centres’ which control bone and joint nutrition. 1 The classical clinical presentation of NA involves joint [nzma.org.nz]
Swelling After an injury, the synovial fluid that leaks out of the joint capsule may produce swelling. [drfoot.co.uk]
If the patient later suffers from chronic arthralgias, corticosteroids should be avoided . Steroids are administered when inflammatory symptoms are resistant to NSAIDs . [physio-pedia.com]
The diagnosis of neurogenic arthropathy rests on the ability of the clinician to raise suspicion toward this disease. In order to gain sufficient evidence, a detailed physical examination and a thorough history are of critical importance. The presence of illnesses that could predispose to this condition, such as diabetes mellitus, must be excluded, while recent trauma is also an important risk factor. Once the course of symptoms, as well as their duration and progression, are assessed, the physical exam should cover a complete neurological workup, including reflex testing and evaluation of the sensory nerves . Neuropathy of any origin can be confirmed by using either the Semmes-Weinstein 5.07/10 g monofilament or simple pinprick testing, whereas the neurometer test might also be employed when possible  . A lower temperature of the affected joint and extremity is readily noted , thus further solidifying the diagnosis of neuropathic origin . To confirm the neurogenic arthropathy, imaging studies need to be performed. Plain radiography, although a very useful method for observing the skeletal system, is of limited benefit due to frequent involvement of soft tissues by local inflammation, which is why magnetic resonance imaging (MRI) is the gold standard    . Scintigraphy, use of Doppler probes, electrophysiology studies, and a skin biopsy are also recommended in the workup of individuals in whom neurogenic arthropathy is suspected .
- Increased Bone Density
Inactive (chronic) condition: Characterized by resolution of inflammation, exuberant ossification, increased bone density, restoration of stability and foot deformity. -- To view the remaining sections of this topic, please sign in or purchase a subscription [hopkinsguides.com]
Surgical indications for the various joints affected are discussed, and the results obtained after treatment are reported. [ncbi.nlm.nih.gov]
Diagnosis and Treatment The diagnostic path begins with recognition of the underlying neuropathy. X-RAY can usually confirm the damage to the joint. [beltina.org]
Treatment Pain relief - the immediate treatment goal- may be achieved with analgesics, nonsteroidal antinflammatory drugs, and joint immobilization (crutches, splints, braces, and weight-bearing restrictions). [medical-clinic.org]
Treatment Treatment of the underlying nerve disorder Surgery to repair or replace joints Treatment of the underlying nerve disorder can sometimes slow or even reverse joint damage. [merckmanuals.com]
Anatomic classification systems are the most commonly used and have the added benefit of predicting outcome and prognosis. [emedicine.com]
The etiology of Charcot joints has varied throughout history as different diseases have become less or more prominent. Some of the offenders include diabetic neuropathy, tabes dorsalis, syringomyelia, and congenital indifference to pain. [ncbi.nlm.nih.gov]
By far, the most common etiology is diabetic neuropathy, affecting up to 13% of cases suffering from severe forms of this ailment. [symptoma.com]
Explore these free sample topics: -- The first section of this topic is shown below -- Etiology Diabetic neuropathy Syringomyelia Spinal cord injury Pernicious anemia Tabes dorsalis (neurosyphilis) Hansen's disease (leprosy) Peripheral neuropathy due [unboundmedicine.com]
Epidemiology Usually occurs 8 to 12 years after diagnosis of DM Seen mostly in the 5th and 6th decades but can be seen in patients as young as 20 years Men females 30% bilateral incidence 77% prevalence in patients with DM Prevalence without DM 11.7% [unboundmedicine.com]
Introduction Clinical definition arthropathy due to underlying neuropathy or trauma, leading to a destruction of joints and bone Epidemiology demographics adults location foot and ankle (most common) shoulder elbows risk factors diabetic neuropathy for [medbullets.com]
Epidemiologic studies do not distinguish between acute and postacute disease. Bilateral disease occurs in less than 10% of patients. Recurrence of disease occurs in less than 5% of patients. [emedicine.com]
Prevalence 0.1% in all patients 0.8–8% in with the general DM population Up to 13% in high-risk diabetic patients ( 3 ) Etiology and Pathophysiology Exact cause is unknown. [unboundmedicine.com]
Pathophysiology The exact nature of Charcot arthropathy remains unknown,  but two major theories exist regarding the pathophysiology of this condition: neurotraumatic and neurovascular. [emedicine.com]
Special shoes and/or braces may be necessary to support the foot to prevent further injury and ulceration of the foot. Sometimes surgery is the only way to make bracing and the use of footwear possible and help prevent amputation. [amputee-coalition.org]
TCC also keeps the ankle from rotating during walking, which prevents shearing and twisting forces that can further damage the wound. [en.wikipedia.org]
Prevention Avoiding injuries and using protective wear, such as splints or special boots Sometimes neurogenic arthropathy can be prevented by taking care of the feet and by avoiding injuries. [merckmanuals.com]
Prevention Prevention of arthropathy may be possible in a patient at risk. [medical-clinic.org]
Pathogenesis and rationale of prevention and treatment. J Bone Joint Surg Am. 1967; 49 :1-30. [ PubMed ] [wjgnet.com]
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- Cullen AB, Ofluoglu O, Donthineni R. Neuropathic Arthropathy of the Shoulder (Charcot Shoulder). MedGenMed. 2005;7(1):29.
- Chakraborty PP, Datta S, Ray S, Bhattacharjee R, Chowdhury S. Unilateral neuropathic arthropathy of the shoulder secondary to syringomyelia: Diagnostic challenges. World J Clin Cases. 2015;3(12):1017-1020.