Learning Radiology xray montage

Neuropathic Joint-Shoulder
Charcot Arthropathy

General Considerations


  • Most commonly caused by diabetes today
  • Bilaterally is rare in foot
  • Disturbance in sensation leads to multiple microfractures
    • Pain sensation is intact from muscles and soft tissue
  • Distribution and causes
    • Shoulders – syringomyelia, spinal tumor
    • Elbows and wrists -- syringomyelia
    • Hips – tertiary syphilis, diabetes
    • Knees – tertiary syphilis (more bone production), diabetes (less bone production)
    • Feet – diabetes, congenital insensitivity to pain, chronic alcoholism
    • Other causes
      • Leprosy
      • Amyloidosis – knee and ankle
      • Congenital indifference to pain
      • Polio
      • Alcoholism

Clinical Findings

  • Signs of inflammation in acute phase
  • Swelling is very common
  • Pain can occur in 75% of cases but is usually less severe than would be expected on the basis of the radiologic findings
  • Instability
  • Loss of joint function
  • May produce a mass at the joint because of swelling

Imaging Findings

  • Conventional radiography is usually sufficient to make the diagnosis
  • Findings include:
    • Sclerosis from eburnation of subchondral bone
    • Destruction of joint
    • Fragmentation
    • Subluxation and dislocation
    • Soft tissue swelling from synovitis may be massive
    • Joint effusions
    • Osteophytosis
    • Disorganized and disrupted joint
    • No osteoporosis

Differential Diagnosis

  • Degenerative joint disease
    • Especially in early stages
    • Eventually neuropathic joint shows more sclerosis
    • More fragmentation in neuropathic
    • More destruction of bone in neuropathic
  • Calcium Pyrophosphate Deposition Disease
    • Associated with chondrocalcinosis which a neuropathic joint is not
    • Also more fragmentation in neuropathic joint
  • Osteomyelitis
    • MRI and nuclear medicine scans, including FDG-PET scans, may help in differentiation


  • Usually non-operative
  • Surgery if unstable, nonreducible fractures or dislocations

Charcot Arthropathy of Shoulder from Syringomyelia

Charcot Arthropathy of Shoulder from Syringomyelia. 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.This patient had a syrinx in the cervical spinal cord.

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Charcot Arthropathy. eMedicine. M Shah and W Panis.