Answer for BIR CoW 06 May 2018
NEUROPATHIC JOINT
Findings
Disorganisation with dislocation of glenohumeral joint. Resorption of head of humerus. Glenohumeral joint is distended with fluid and osseous debris Destruction of glenoid labrum with erosions. Features suggestive of neuropathic joint – atrophic type.
Discussion
NEUROPATHIC JOINT :Progressive Degenerative /Destructive Joint Disorder In Patients With Abnormal Pain Sensation And Proprioception LOCATION: wrist: diabetes, syringomyelia hip: alcohol, tabes dorsalis knee: tabes dorsalis, congenital insensitivity to pain ankle and foot: diabetes spine: spinal cord injury, diabetes, tabes dorsalis There are two forms of Charcot joint: atrophic and hypertrophic. Atrophic form most common form occurs earlier has an acute progression characterised by reabsorption of the ends of the affected bone joint destruction with resorption of fragments an absence of osteosclerosis and osteophytes mainly occurs in non-weight bearing joints of the upper limb 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 absence of osteoporosis (unless joint is infected) Plain radiograph and CT: dense bones (subchondral sclerosis) degeneration destruction of articular cartilage deformity (pencil-point deformity of metatarsal heads) debris (loose bodies) dislocation
REFERENCES: radiopaedia.org/articles/charcot-joint www.researchgate.net/publication/226199659... patient.info/.../neuropathic-joints-charcot-joints www.sciencedirect.com/science/article/pii/... emedicine.medscape.com/article/1234293-overview
Findings
Disorganisation with dislocation of glenohumeral joint. Resorption of head of humerus. Glenohumeral joint is distended with fluid and osseous debris Destruction of glenoid labrum with erosions. Features suggestive of neuropathic joint – atrophic type.
Discussion
NEUROPATHIC JOINT :Progressive Degenerative /Destructive Joint Disorder In Patients With Abnormal Pain Sensation And Proprioception LOCATION: wrist: diabetes, syringomyelia hip: alcohol, tabes dorsalis knee: tabes dorsalis, congenital insensitivity to pain ankle and foot: diabetes spine: spinal cord injury, diabetes, tabes dorsalis There are two forms of Charcot joint: atrophic and hypertrophic. Atrophic form most common form occurs earlier has an acute progression characterised by reabsorption of the ends of the affected bone joint destruction with resorption of fragments an absence of osteosclerosis and osteophytes mainly occurs in non-weight bearing joints of the upper limb 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 absence of osteoporosis (unless joint is infected) Plain radiograph and CT: dense bones (subchondral sclerosis) degeneration destruction of articular cartilage deformity (pencil-point deformity of metatarsal heads) debris (loose bodies) dislocation
REFERENCES: radiopaedia.org/articles/charcot-joint www.researchgate.net/publication/226199659... patient.info/.../neuropathic-joints-charcot-joints www.sciencedirect.com/science/article/pii/... emedicine.medscape.com/article/1234293-overview
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!