Charcot's Joint

Examine this patient's joints.

Examine the locomotor system in this patient.

· Enlargement of the affected joint (compare with the other side).

· Instability of the joint, in particular hypermobility of the joint.

· May be warm, swollen and tender in the early stages.

· Enlargement and crepitus may be present in the later stages.

· Check sensation in the affected limb.

· Tell the examiner that you would like to investigate as follows:

-Do a thorough neurological examination, looking for loss of proprioception,

and/or pain sensation, and vibratory sensation with a 128 Hz tuning fork.

- Examine the urine for sugar (looking for evidence of diabetes mellitus).

-Ask for lancinating pains, check posterior column signs and look for Argyll

Robertson pupil (tabes dorsalis).

-Check for dissociated sensory loss (syringomyelia).

-Test muscle strength.

This patient has Charcot's joint (lesion) due to diabetes mellitus (aetiology) and has marked deformity of the joint with restricted

movement (functional status).

It is a chronic progressive degenerative arthropathy resulting from a disturbance in the sensory innervation of the affected joint. It is a neuropathic arthropathy which represents a complication of various disorders affecting the nervous system. It results in gross deformity, osteoarthrosis and new bone formation from repeated trauma.

· Diabetic neuropathy - affecting tarsal joints, tarsometatarsal, metatarso-phalangeal joints.

· Tabes dorsalis - affecting knee, hip, ankle, lumbar and lower dorsal vertebrae.

· Syringomyelia - affecting shoulder, elbow, cervical vertebra.

· Myelomeningocele - affecting ankle, tarsus.

· Miscellaneous: hereditary sensory neuropathies, peripheral nerve injury, congenital insensitivity to pain, leprosy.

Jean Martin Charcot (1825-1893) was a French neurologist. He was a Professor of Pathology in 1872 and Professor of Nervous Diseases in 1882. The other conditions that bear his name include the following: Charcot's fever (intermittent fever due to cholangitis), Charcot's triad (intention tremor, nystagmus and scanning speech in multiple sclerosis), Charcot-Leyden crystals (seen in the sputum of asthmatics), Charcot-Marie-Tooth disease (peroneal muscular atrophy), Charcot-Wilbrand syndrome (visual agnosia).