Charcot joint

Changed by Henry Knipe, 14 Oct 2014

Updates to Article Attributes

Body was changed:

A Charcot joint (also known as a neurotrophic joint) refers to a progressive degenerative / destructive/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/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

EtymologyHistory and 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.

  • -<p>A <strong>Charcot joint</strong> (also known as a <strong>neurotrophic joint</strong>) refers to a progressive degenerative / destructive joint disorder in patients with abnormal pain sensation and proprioception <sup>1</sup>.</p><h4>Epidemiology</h4><p>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: </p><ul>
  • +<p><strong>Charcot joint</strong> (also known as a <strong>neurotrophic joint</strong>) refers to a progressive degenerative/destructive joint disorder in patients with abnormal pain sensation and proprioception <sup>1</sup>.</p><h4>Epidemiology</h4><p>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: </p><ul>
  • -<li>wrist - diabetes, <a href="/articles/syringomyelia">syringomyelia</a>
  • +<li>wrist: diabetes, <a href="/articles/syringomyelia">syringomyelia</a>
  • -<li>hip - alcohol, <a href="/articles/tabes-dorsalis">tabes dorsalis</a>
  • +<li>hip: alcohol, <a href="/articles/tabes-dorsalis">tabes dorsalis</a>
  • -<li>knee - <a href="/articles/tabes-dorsalis">tabes dorsalis</a>, congenital insensitivity to pain</li>
  • -<li>ankle and foot - diabetes</li>
  • -<li>spine - spinal cord injury, diabetes, <a href="/articles/tabes-dorsalis">tabes dorsalis</a>
  • +<li>knee: <a href="/articles/tabes-dorsalis">tabes dorsalis</a>, congenital insensitivity to pain</li>
  • +<li>ankle and foot: diabetes</li>
  • +<li>spine: spinal cord injury, diabetes, <a href="/articles/tabes-dorsalis">tabes dorsalis</a>
  • -<li>joint destruction with periarticular debris / bone fragmentation</li>
  • +<li>joint destruction with periarticular debris/bone fragmentation</li>
  • -<li>presence of osteosclerosis and osteophytes<sup>1</sup>
  • +<li>presence of osteosclerosis and osteophytes <sup>1</sup>
  • -</ul><h4>Radiographic features</h4><p><strong>Mnemonic</strong> - <a href="/articles/6-ds">6 Ds</a> <sup>1</sup></p><ul>
  • +</ul><h4>Radiographic features</h4><p><strong>Mnemonic</strong>: <a href="/articles/6-ds">6 Ds</a> <sup>1</sup></p><ul>
  • -<li>advanced <a href="/articles/osteomyelitis">osteomyelitis </a>- can co exist (especially in the foot) <sup>4-5</sup>
  • +<li>advanced <a href="/articles/osteomyelitis">osteomyelitis</a>: can co exist (especially in the foot) <sup>4-5</sup>
  • -<a href="/articles/tuberculous-spondylitis-1">tuberculous spondylitis</a> / <a href="/articles/pott-disease">Pott's disease</a> (in the spine) </li>
  • +<a href="/articles/tuberculous-spondylitis-1">tuberculous spondylitis</a>/<a href="/articles/pott-disease">Pott's disease</a> (in the spine) </li>
  • -<a href="/articles/chondrosarcoma">chondrosarcoma</a> (shoulder) - <a href="/articles/chondroid-matrix">chondroid matrix</a> instead of bony debris</li>
  • -<li>inflammatory <a href="/articles/osteoarthritis">osteoarthritis</a> / arthritis - early stages can resemble Charcot's joint</li>
  • -</ul><h4>Etymology</h4><p>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.</p>
  • +<a href="/articles/chondrosarcoma">chondrosarcoma</a> (shoulder): <a href="/articles/chondroid-matrix">chondroid matrix</a> instead of bony debris</li>
  • +<li>inflammatory <a href="/articles/osteoarthritis">osteoarthritis</a>/arthritis: early stages can resemble Charcot's joint</li>
  • +</ul><h4>History and etymology</h4><p><strong>Jean-Martin Charcot</strong> 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.</p>
Images Changes:

Image ( update )

Caption was changed:
Case 2 -: with Lisfranc fracture - dislocation-dislocation

Image 1 CT (bone window) ( update )

Caption was changed:
Case 1 -: involving spine

Image 10 MRI (T1) ( update )

Caption was changed:
Case 9 -: diabetic neuropathy

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