134 Charcot’s joint
Salient features
Examination
• 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
• Collapse of the longitudinal arch resulting in a rocker-bottom deformity.
• Check sensation in the affected limb
• Tell the examiner that you would like to investigate as follows:
• Ask for lancinating pains, check posterior column signs and look for Argyll Robertson pupil (tabes dorsalis)
• Check for dissociated sensory loss (syringomyelia)
Diagnosis
This patient has Charcot’s joint (lesion) caused by diabetes mellitus (aetiology) and has marked deformity of the joint with restricted movement, probably belonging to Rogers and Bevilacqua class 3C or 3D (functional status) (Fig. 134.1).
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