Neuropathic (Charcot) Arthropathy

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• Disturbance in sensation leads to multiple microfractures
  • Pain sensation is intact from muscles and soft tissue
• Distribution and causes
  • Shoulders – syrinx, spinal tumor
  • Hips – tertiary syphilis, diabetes
  • Knees – tertiary syphilis (more bone production), diabetes (less bone production)
  • Feet – diabetes
  • Other causes
    • Amyloidosis
    • Congenital indifference to pain
    • Polio
    • Alcoholism
       
• X-ray findings
  • Sclerosis
  • Destruction of joint
  • Fragmentation
  • Soft tissue swelling from synovitis
  • Joint effusions
  • Osteophytosis
  • Disorganized and disrupted joint
  • No osteoporosis
     
• DDX
  • Degenerative joint disease
    • Eventually neuropathic joint shows more sclerosis
    • More fragmentation in neuropathic
    • More destruction of bone in neuropathic
  • CPPD
    • Associated with chondrocalcinosis which a neuropathic joint is not