(Neuropathic arthropathy, Charcot joints; Charcot’s joints)
When neurogenic arthropathy is a rapidly destructive progressive arthropathy that occurs on the basis of impaired pain perception and attitude regulation. Several diseases, v. a. Diabetes mellitus and stroke can be based. The most common manifestations include swelling and effusion, deformity and instability. Because of the underlying neuropathy the accompanying pain is disproportionately low. The diagnosis is confirmed radiographically. For therapy include the immobilization of the joint, which slows the progression of, and sometimes in an advanced state, the surgical intervention.
When neurogenic arthropathy is a rapidly destructive progressive arthropathy that occurs on the basis of impaired pain perception and attitude regulation. Several diseases, v. a. Diabetes mellitus and stroke can be based. The most common manifestations include swelling and effusion, deformity and instability. Because of the underlying neuropathy the accompanying pain is disproportionately low. The diagnosis is confirmed radiographically. For therapy include the immobilization of the joint, which slows the progression of, and sometimes in an advanced state, the surgical intervention. Pathophysiology Many conditions predispose to neurogenic arthropathy (see Table: Underlying diseases in neurogenic arthropathy). Impaired deep sensation of pain, and proprioception lead to a reduction of protective reflexes of the joint, thereby trauma remain (v. A. Repetitive micro trauma) and small periarticular fractures unnoticed. Also helps to increase bone blood flow (by reflex vasodilatation) at about increased bone resorption and bone and joint damage. which must withstand the joint each new injury, ensures more harm than healing. Haemorrhagic joint effusion and multiple small fractures are not uncommon, they accelerate the destructive processes. Ligamentous laxity, muscular hypotonia and the rapid destruction of articular cartilage are common and predispose to joint instability, -dislokation and progression of the disease. The advanced neuropathic arthropathy causes hypertrophic changes, destructive changes, or both. Underlying diseases in neurogenic arthropathy amyloid neuropathy (secondary amyloidosis) Arnold-Chiari malformation Congenital insensitivity to pain Degenerative spine disease with nerve root compression diabetes mellitus Family-hereditary neuropathies: Familial amyloid polyneuropathy Familial dysautonomia (Riley-Day syndrome) Hereditary sensory neuropathy Hypertrophic interstitial neuropathy (Dejerine-Sottas disease) peroneal muscular atrophy (Charcot-Marie-Tooth disease) gigantism with hypertrophic neuropathy Leprosy spina bifida with myelomeningocele combined (in children) Subacute degeneration of spinal cord syringomyelia tabes dorsalis Tumors and injuries of peripheral nerves and spinal cord symptoms and complaints Usually takes the arthropathy until years after the start of underlying neurological disorder on, she then proceeds but rapidly progressive and may lead within months to complete disorganization of the joint. Although pain is an early symptom, but measured at the joint damage due to the underlying neurological disorder inadequately low. At an early stage, a haemorrhagic effusion, subluxation and instability of the joint found. An acute dislocation may also occur. In later stages, the pain intensity may increase when the disease has led to the massive joint destruction (eg., By peri-articular fractures, or by tight hematoma). In this advanced stage, the joint is swollen by bone overgrowth and a massive effusion. Deformities caused by dislocation and bone-dislocating after fractures. Fractures and bone repair can occur, fall into the joint and there cause a sand-like rubbing and often audible crepitus, which is unpleasant for the examiner as for the patients. Many free cartilage and bone pieces The joint then feels like a “bag of bones” to. Although many joints may be affected as, knee and ankle joints are most often affected. The joint distribution is determined by the underlying disease. As concerns the locomotor ataxia v. a. Knee and hip, diabetes mellitus foot and ankle. Syringomyelia concerns v. a. the spine and upper extremities, v there. a. Elbow and shoulder. Often, only one joint and rarely more than two or three (apart from the small ankles) are affected in an asymmetrical shape. As a complication of septic arthritis can occur with or without system manifestations (eg. As fever or malaise), v. a. in diabetics. Blood vessels, peripheral nerves or the spinal cord may be compressed by Gewebehypertrophie. Diagnostic X-rays In the event of a destructive, remarkably painless arthropathy associated with predisposing neurological disease that already is usually several years, should be considered in the diagnosis of neurogenic arthropathy. In case of suspected radiographs should be made. The combination of the predisposing disease, the typical clinical symptoms and signs and a characteristic X-ray confirms the diagnosis. In the early stage of the radiographic findings similar to the often osteoarthritis (OA-s. Diagnostics). The main characters are bone fragmentation and -destruktion about shooting new bone growth and loss of the joint space. Also effusion and joint subluxation may occur. Later it comes to bone deformity, and also, particularly in long bones, the formation of new bone near the cortical bone, which starts from the joint capsule and extending along the shaft. More rarely occur calcification and ossification in the soft tissues. Large, oddly shaped osteophytes may be present at the joint borders or within the joint. Grobwulstige spinal osteophytes often form in the absence of clinical signs of spinal disease. Osteoarthritis (OA) of the hip illustration provided by Roy Altman, M.D. var model = {thumbnailUrl: ‘/-/media/manual/professional/images/osteoarthritis_oa_of_the_hip_orig_de.jpg?la=de&thn=0&mw=350’ imageUrl: ‘/-/media/manual/professional/images/osteoarthritis_oa_of_the_hip_orig_de.jpg?la = de & thn = 0 ‘, title:’ osteoarthritis (OA) of the hip “, description: ‘ u003Ca id = ” v38395299 “”class = “” anchor “” u003e u003c / a u003e u003cdiv class = “” para “” u003e u003cp u003eAuf this X-ray image can be seen characteristic changes of osteoarthritis as large femoral and acetabular osteophytes with a slight narrowing of the upper joint space u003c / p u003e u003c / div u003e ‘credits’. Figure provided by Roy Altman