Clinical Features Charcot Joints In Children
In a normal limb, the injured joint is protected from further trauma by pain. In the absence of pain and proprioceptive sensation, however, the joint continues to be active and is repeatedly injured.
Synovial effusion and hemarthrosis are aggravated and, together with the abnormal stresses on the joint, cause extreme stretching and weakening of the capsule and supportive ligaments.
Local hyperemia causes bone atrophy and resorption.
Cartilage destruction, bone erosion, and minute fractures soon follow. Reparative response results in the formation of callus and metaplastic changes in surrounding traumatized soft tissues. With repeated injury, the joint becomes totally disorganized, subluxation ensues, and severe degenerative changes take place.
The affected joints are boggy, tense, swollen, nontender, and have an excessively abnormal range of motion on clinical examinaion. The local triad of swelling, instability, and absence of pain is nearly always suggestive of Charcot joint.
Radiographic Findings
The joint will show varying degrees of destructive and hypertrophic changes. There is loss of articular cartilage, fragmentation and absorption of subchondral bone, and osseous proliferation of the articular margins.
The bone overgrowth may be enormous, bizarre in configuration, and so great as to surround the joint as a spongy mass. The periarticular soft tissues are thickened and contain scattered calcifications.
Pathologic fractures involving the articular surface are common, as are irregular loose bodies within the joint.
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