 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.
 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%

NEUROTRAUMATIC THEORY;
An unperceived trauma or injury to an insensate
joint.

NEUROVASCULAR THEORY:
autonomic neuropathy increase vascularity
mismatch in destruction & synthesis
 Genetics molecular biology
 RANK/RANKL/OPG triad pathway is thought to be
involved
 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
 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
 AP radiography
shows fragmentation
and joint destruction.
 AP radiograph shows
joint destruction and
dislocation.
Elbow

 syringomyelia
 syphilis
 congenital insensitivity to pain
 diabetes
 Charcot-Marie-Tooth
 AP radiograph shows
joint destruction and
heterotrophic
ossificans.
 X rays showing joint
destruction and
dislocation
 X rays shows joint
destruction and new
bone formation
 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
 Stage 0
 Hot foot
 X rays normal
 MRI shows marrow
edema and micro
fractures
 Stage 1
(Hydrarthrosis)
 Fragmentation
 Bone resorption
 Fracture
 dislocation
 Stage 2 ( Atrophy)
 Coalescence
 Sclerosis
 Fracture healing
 Debris resorption
 Stage 3
( Hypertrophy)
 Remodeling
 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
 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
 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
 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)
 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
 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
 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
An ounce of prevention is worth a pound of
cure.”

– Benjamin Franklin