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Charcot joint

A Charcot joint (also known as a neurotrophic joint) refers to a progressive degenerative / destructive joint disorder in patients with abnormal pain sensation and proprioception 1.

Epidemiology

In modern western societies by far the most common cause of Charcot joints is diabetes, and therefore the demographics of patients matches those of older diabetics. Causes include: 

These can be recalled using the mnemonic - DS6 1. The involved joint is highly suggestive of the aetiology: 

Clinical presentation

Patients typically present insidiously or are identified incidentally or as a result of investigation for deformity. Unlike septic arthritis, Charcot joints although swollen are normal temperature without elevated inflammatory markers. Importantly they are painless. 

Pathology

Two forms exist (atrophic and hypertrophic). 

Atrophic form
  • most common form 1
  • occurs earlier 2
  • has an acute progression
  • characterised by reabsorption of the ends of the effected bone
  • joint destruction with resorption of fragments
  • absence of osteosclerosis and osteophytes
  • mainly occurs on non weight bearing joints of the upper limb 1
Hypertrophic form
  • only sensory nerves effected
  • slow progression
  • joint destruction with periarticular debris / bone fragmentation
  • initially widened then narrowed joint space
  • presence of osteosclerosis and osteophytes1
  • absence of osteoporosis (unless joint is infected) 3

Radiographic features

Mnemonic - 6 Ds 1

  • dense bones (subchondral sclerosis)
  • degeneration 
  • destruction of articular cartilage
  • deformity (pencil-point deformity of metatarsal heads)
  • debris (loose bodies)
  • dislocation

Differential diagnosis

Imaging differential considerations include

Etymology

Jean-Martin Charcot was the first person to give a detailed description of the neuropathic aspect of this condition in the year 1868 in a patient suffering with syphilis.

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