Charcot arthropathy

Osteoartropatia can be defined as neuropathic joint and bone changes that occur secondary to loss of sensation and accompanies a variety of diseases. Charcot first described the relationship between loss of sensation and pathological articular changes in 1868.Charcot joint or neuropathic joint is a progressive condition characterized by musculoskeletal system of shoulder dislocation, pathologic fractures and debilitating deformities. This condition causes progressive destruction of bone and soft tissue and cause severe form dissolved in bone architecture. Charcot arthropathy can affect any joint but most commonly involves the lower extremity.
Any condition that causes sensory or motor neuropathy can lead to Charcot joint. This may be a complication of diabetes, syphilis, chronic alcoholism, leprosy, meningomyelocele, spinal cord injuries, siringomieliei, kidney dialysis and congenital insensitivity to pain. Diabetes is considered the most common cause of Charcot arthropathy.The clinical presentation of Charcot joints vary widely depending on the stage of disease, as symptoms vary from moderate to slight edema and swelling up to severe deformation. Acute Charcot arthropathy presents with signs of inflammation. These characteristics in the presence of an intact skin and loss of protective sensation are specific for acute Charcot arthropathy.Pain occurs in most patients. Instability and loss of joint function are also present.
Treatment of Charcot arthropathy is primarily nonoperative.Treatment includes immobilization and reduction of acute mechanical stress. Immobilisation is performed by allowing the patient to go to hearing and prevent warping. Other methods of restraint are metal rods and ortozele. Surgical therapy prolongs healing time and is indicated in the development joint deformity.The extension also affects the healing wound. The more severe is the injury is healing so late and permanent deformation may occur.It generally requires 1-2 years for complete healing
Pathogenesis
The exact cause of Charcot arthropathy is still unknown, but there are several theories about the pathophysiology of the condition.Nontraumatic theory assumes that arthropathy is caused by trauma or injury to a leg uncollected insensitive. Sensory neuropathy patient does not announce the destruction of bone that occurs with outpatient. This microtrauma leads to progressive destruction and bone and joint damage. Neurovascular theory suggests that provided the background leading to the development of autonomous neuropathy and increased blood flow disorders in extremities and synthesis of bone destruction, leading to osteopenia.Charcot arthropathy most often result from the combination of processes described in the above theories. Autonomous neuropathy lead to abnormal formation of bone and joint sensory neuropathy succeptibila insensitive to the trauma. The development of an abnormal bone protection without the possibility of bone fracture and subluxation lead to articular joint.
Causes and risk factors:-Diabetes, steroid therapy, alcoholism, trauma-Infection, amyloidosis, pernicious anemia-Syphilis, siringomielia, spina bifida, leprosy, multiple sclerosisCharcot-Marie-Tooth disease, spinal cord compressionEhlers-Dnalos-syndrome, Raynaud's disease, adrenal hypercorticismParaneoplazica-neuropathy.
Neuropathic arthropathy can be classified into hypertrophic and atrophic. Hypertrophic changes in the predominant upper motor neuron lesions, and the atrophic lesions in peripheral nerves.Stimulates the early stage of osteoarthritis osteoartropatia neuropathic.Epansamentele progressive joint, fracture, fragmentation and subluxarea raise suspicion of neuropathy. The radiographic evidence suggestive of ages submitted include subchondral sclerosis, osteophytosis, soft tissue swelling and subluxation.Duration of neuropathy is characterized by considerable disruption of articular cartilage and bone debris in synovium-dendritic synovitis.Neuropathy associated with diabetes is more common in developed countries and the associated infection: syphilis, leprosy in undeveloped countries.