Neuropathic Bone Disease Flashcards
Neuropathic bone disease is aka?
charcot arthropathy
explain the pathophysiology of charcot arthropathy?
due to loss of autonomics in neuropathy, the effect on blood vessels is the loss of vasoconstriction so there is unopposed vasodilation. The increased blood flows cases washout of bone minerals and increased oxygen tension which stimulates osteoclast activity –> destruction of bone
Charcot foot is characterized by joint dislocation, pathological fractures, and severe destruction of the pedal architecture.
true
what are common etiologies for Charcot arthropathy?
diabetes ***** Tabes dorsalis leprosy syringomyelia steroids alcoholism pernicious anemia spinal disroders: MS, CMT paraneoplasms
explain the neurotraumatic theory.
- exagerrated overuse injury coupled with loss of protective sensation
- can be initiated by acute trauma or repetitive microtrauma
- lack of sensation allows continued tissue destruction resulting in fractures and dislocations
explain the neurovascular theory.
- vasomotor neuropathy in patients with intact blood flow
- arteriovenous shunting leads to excessive bone resorption and bone weakening
- contributes to fractures and dislocations with continued weightbearing
recall the role RANKL has.
stimulates osteoclastic activity
RANKL is unopposed in neuropathy –> increased bone destruction
risk factors for development of charcot arthropathy
neuropathy plantar pressure ulceration age obesity, trauma, instability,
what is stage 1 of Charcot arthropathy? explain clinical symptoms and radiographic findings.
(development-fragmentation)
- erythema, warmth, swelling
- bony debris at joints; subluxation/dislocation; fragmentation of bone
what is stage 2 of Charcot arthropathy? explain clinical symptoms and radiographic findings.
(coalescence)
- decreased erythema, swelling, warmth
- absorption of fine debris; new bone formation; colaescence of larger fragments
what is stage 3 of Charcot arthropathy? explain clinical symptoms and radiographic findings.
(reconstruction-consolidation)
- resolution of edema, residual deformity
- remodeling; rounding of bone; decreased sclerosis
Using Brodsky classification, where does the vast majority of breakdown occur in charcot arthropathy?
Type 1 : tarsometatarsal (Lisfranc’s)
List the 3 most common locations for charcot arthropathy to affect the foot in decreasing order.
- Type 1: Lisfranc’s tarsometatarsal (60%)
- type 3a: ankle (20%)
- type 2: chopart’s/ subtalar (10%)
clinical features of Charcot arthropathy
- red, hot swollen foot
- temp difference (3-6 deg)
- sensory neuropathy
- some pain may be present
- bilateral 9-30% of time
DDx ?
- infection
- RA
- osteoarthritis
- gout
- osteomyelitis
