musculoskeletal and connective tissue disorders
Neurogenic Arthropathy
Diagnosis of Neurogenic Arthropathy
X-rays The diagnosis of neurogenic arthropathy should be considered in a patient with a predisposing neurologic disorder who develops a destructive but unexpectedly painless arthropathy, usually several years after the onset of the underlying neurologic condition. If neurogenic arthropathy is suspected, x-rays should be taken. Diagnosis is established by characteristic x-ray abnormalities in a patient with a predisposing condition and typical symptoms and signs. X-ray abnormalities in early-stage neurogenic arthropathy are often similar to those in osteoarthritis (see Diagnosis ). The cardinal signs later in disease progression are Bone fragmentation Bone destruction New bone growth Loss of joint space There may also be synovial effusion and joint subluxation. The bones may become deformed, and new bone forms adjacent to the cortex, starting within the joint capsule and often extending up the shaft, particularly in long bones. Rarely, calcification and ossification occur in the soft tissues. Large, bizarrely shaped osteophytes may be present at the joint margins or within joints. Large curved (parrot’s beak) osteophytes frequently develop in the spine in the absence of clinical spinal disease. In its early stages, neurogenic arthropathy can simulate osteoarthritis. However, neurogenic arthropathy progresses more rapidly than osteoarthritis and frequently causes proportionately less pain. 