Revision 37 for 'Charcot joint'

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Charcot joint

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


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. These can be recalled with the "S" mnemonic. Causes include: 

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

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. 


Two forms exist - atrophic and hypertrophic. 

Atrophic form
  • most common form 1
  • occurs earlier 2
  • has an acute progression
  • characterized by reabsorption of the ends of the affected 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 affected
  • slow progression
  • joint destruction with periarticular debris/bone fragmentation
  • initially widened then narrowed joint space
  • presence of osteosclerosis and osteophytes 1
  • absence of osteoporosis (unless joint is infected) 3

Radiographic features

Mnemonic6 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

History and etymology

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

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