MCQ – 72001

A 60 year old male suffering from syrinx in the cervical spinal cord,presented with a history of swelling of right shoulder joint.Xray shows the following features.What can be the most possible diagnosis?

A.	Rheumatoid Arthritis
B.	Shoulder Dislocation
C.	Charcot’s Joint
D.	Osteoarthritis

Show Answer

Correct Answer � C Explanation

Ans:C.)Charcot’s Joint.

Image shows:The hallmarks of Charcot arthropathy are fragmentation of bone (white arrows), destruction of the joint (black arrows), soft tissue swelling and sclerosis of bone. The shoulder “joint” is dislocated.

NEUROPATHIC JOINT OR CHARCOT’S JOINT

• Progressive destructive arthritis from loss of pain sensation and proprioception (position sense)

Causes :

• Diabetes mellitus (tarsal , tarsometatarsal) – most common cause; downward collapse of the tarsal bones leads to convexity of the sole (rocker foot)
• Tabes dorsalis (knee, hips, ankles)
• Meningomyelocele
• Syringomyelia (shoulder, elbow)
• Amyloidosis
•  Leprosy (hands, feet)

X-ray

•  Changes of osteoarthritis with joint space narrowing, subchondral bone sclerosis, osteophytes, and joint effusions followed by marked destructive and hypertrophic changes
• The joint margins in a neuropathic joint tend to be distinct, while in osteomyelitis, they are blurred.
• 6Ds of Charcot joint:
  • increased Density (subchondral sclerosis)
  • Destruction
  • Debris (intra-articular loose bodies)
  • Dislocation
  • Distention
  • Disorganisation.