Neuropathic arthropathy

Introduction to neuropathy Charcot first described neurological joint disease in 1868, also known as charcot joint disease, which is Charcot's joint disease. These diseases are caused by no pain and are called painless joint diseases. They are a destructive joint disease secondary to neurosensory and neurotrophic disorders. They are common in 40 to 60 years old, male: female = 3: 1. basic knowledge The proportion of illness: 0.0003% Susceptible people: no special people Mode of infection: non-infectious Complications: Osteoporosis

Causes of neurological joint disease

The disease can occur in the central nervous system syphilis, syringomyelia, diabetic neuropathy, spinal cord bulging, lack of congenital pain, etc., when the shoulder, elbow, cervical vertebra, hip, knee, ankle, toe and other joints are not The protective mechanism of pain causes overuse of joints and destruction of impact. In addition, long-term use of corticosteroids (such as rheumatoid arthritis, systemic lupus erythematosus and organ transplantation), painkillers (baotaisong, indomethacin) The pathogenesis of iatrogenic joint destruction is the same. The syringomyelia of the cervical spinal cord is a common neurological disease involving the upper extremity joints. The shoulder, elbow, cervical vertebrae and wrist are involved in multiple sites. The syringomyelia is associated with upper limb joint destruction. About 25%, in addition to joint lesions, there are unilateral or bilateral temperature loss, so the upper limb skin can be seen burn scars, spinal syphilis, also known as spinal cord spasm, often involving the knee, hip, ankle and lumbar vertebrae, bone, joint changes In addition, it can be seen that exercise ataxia, deep sensory dysfunction of the lower limbs, Arggll-Robertson pupil, positive for serum Kangwar reaction, spinal cord bulging, sputum and foot joints More common, painful ulcers on the soles of the feet, soft tissue masses in the lumbosacral region, sunken or hairy skin, loss of muscle atrophy in the lower extremities and dysfunction of the sphincter, diabetic neuropathy, can occur in the small joints (, Toe, toe, etc.) painless swelling and so on.

Neurological joint disease prevention

Prevention of joint disease is possible. For patients with painless fractures, early diagnosis and fixation of painless fractures (with splints, special boots or double feet) can prevent neurogenic joint disease. Joints with significantly destructive structure, intra-articular fixation, compression techniques, and appropriate bone graft surgery may be successful. When the disease is in non-progression, total hip and knee replacement can achieve good results. However, artificial joints Loose and dislocated conditions are still the main dangers. Effective treatment of primary neurological disorders will slow the progression of joint lesions. If joint damage is still in the early stages, joint lesions can be reversed.

Neurological joint disease complications Complications Osteoporosis

The biggest characteristic of this disease is that the degree of joint destruction is not proportional to the pain. After the patient's onset, the time of treatment is often delayed due to no pain or slight pain, resulting in further destruction of the joint. Later, due to poor nutrition of the joint nerve, it is easy to cause osteoporosis. Weight-bearing joints are prone to comminuted fractures and are less sensitive to pain.

Symptoms of neurological joint disease Common symptoms Painful joint pain Joint swelling

Neurological joint disease is gradually enlarged, unstable, effusion, joints can wear bleeding-like fluid, swollen joints without pain or only slight pain, joint function is not restricted, joint pain and function limitation and joint swelling damage Inconsistent with the characteristics of this disease, advanced, joint damage further development, can lead to pathological fractures or pathological joint dislocation.

Examination of neurological joint disease

There are three main methods for examining this disease:

(1) X-ray examination

Usually, the X-ray manifestations of the disease are divided into three types, namely, absorption type, proliferative type, mixed type, degenerative changes of the joints visible on the X-ray, mild sclerosis of the articular surface, erosion and destruction, and joints of the affected bone in the late stage of the disease. End hardening is more obvious, with bone hyperplasia, destruction, periosteal reaction, joint deformity, irregular articular surface, collapse, narrow joint space, joint dislocation or subluxation, soft tissue swelling around the joint, irregular calcified or broken bone in soft tissue Tablets, severe joint damage and mild pain of patients, dysfunction is extremely inconsistent with the clinical features of this disease, X-ray can show the basic characteristics of neuroarthropathy, but X-ray can not determine the specific range and product of joint cavity effusion The amount of fluid cannot distinguish the soft tissue density caused by joint effusion and soft tissue swelling. Sometimes it is impossible to distinguish whether the free bone is in the joint cavity or in the soft tissue around the joint.

(2) CT examination

Because CT has the advantages of high resolution, it can better display the structure of the lesion, bone destruction and the condition of adjacent soft tissue. It can distinguish whether the free body shown by X-ray is located in the joint cavity or soft tissue, although the plain film is the diagnosis. The first choice and basic method of the disease, but due to the wide application of CT and high resolution, the combination of CT and X-ray can clearly show the lesion, help to determine the specific range of the effusion of the joint cavity and the amount of fluid, and distinguish the joint product. The soft tissue density caused by swelling of fluid and soft tissue is increased. Whether the free bone mass is in the joint cavity or the soft tissue around the joint, CT can be used as an important inspection method for cases where the plain film cannot be diagnosed or difficult to determine the extent of the lesion.

(3) MRI examination

The MRI images of the musculoskeletal system have a good natural contrast. MRI can clearly display the anatomical morphology and provide information on biochemistry and pathology. The bone tissue shows very low signal on MRI, but still under the background of bone marrow tissue and extra-bone soft tissue. It can clearly show its morphology and structure. Normal adult bone marrow has higher signal on T1WI and T2WL due to fat content. MRI is not sensitive to calcification and ossification of bone and soft tissue, and it is difficult to display fine or thin calcification and bone. It is sometimes referred to as plain film and CT. For the diagnosis of neuropathy, MRI helps to determine the extent and extent of the lesion, which is a necessary complement to X-ray and CT.

Diagnosis and diagnosis of neuropathy

diagnosis

Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.

Differential diagnosis

1. Knee intraosseous cyst is a subchondral X-ray translucent area, and the intracapsular sac becomes characteristic. This lesion occurs in middle-aged people. The clinical symptoms are mild and there is no history of injury. The X-ray is often long. The femoral condyle or flat bone, the subcapsular area of the articular cartilage appears cystic, often isolated, the edge of the cyst is clear, the edge of the lesion has sclerotic bone, especially in the non-weight-bearing area of the joint, the pathological features are single room Sexual or multi-atrial cystic structure, the cavity contains white or yellow gelatinous substance, the edge is wrapped with fibrous tissue pad, the characteristics of intracapsular cyst, including the cystic cavity in the non-weight-bearing area of the joint, the cyst often Hair, the range of lesions is larger, the relative symptoms are lighter, have more normal joint activities, etc., and can be differentiated from degenerative osteoarthrosis.

2, rheumatoid arthritis lesions around the joints of the bones sparse, joint space diffuse stenosis, subchondral scattered, multiple small cystic cavity translucent shadow, the joint synovium is mainly invaded, this is rheumatoid arthritis Characteristic performance.

3, ankylosing spondylitis, psoriatic arthritis, serum-negative spondyloarthropathy can be seen in bone hyperplasia, but often at the edge of the joint is not clear, often manifested as intra-articular bone connection, bone rigidity is characterized, early stages of these diseases, Lesions often erode the edges of the joints, the joint space is often narrow and uniform, and characterized by calcification calcification.

4. Gouty arthritis.

5, osteonecrosis.

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