musculoskeletal and connective tissue disorders
Neurogenic Arthropathy
Symptoms and Signs of Neurogenic Arthropathy
Arthropathy does not usually develop until years after onset of the neurologic condition but can then progress rapidly and lead to complete joint disorganization in a few months. Pain is a common early symptom. However, because the ability to sense pain is commonly impaired, the degree of pain is often unexpectedly mild for the degree of joint damage. A prominent, often hemorrhagic, effusion and subluxation and instability of the joint are usually present during early stages. Acute joint dislocation sometimes occurs also. During later stages, pain may be more severe if the disease has caused rapid joint destruction (eg, periarticular fractures or tense hematomas). During advanced stages, the joint is swollen from bony overgrowth and massive synovial effusion. Deformity results from dislocations and displaced fractures. Fractures and bony healing may produce many loose pieces of cartilage or bone that can slough into the joint, causing a coarse, grating, often audible crepitus usually more unpleasant for the observer than for the patient. Although many joints can be involved, the knee and the ankle are most often affected. Distribution depends largely on the underlying disease. Thus, tabes dorsalis affects the knee and hip, and diabetes mellitus affects the foot and ankle. Syringomyelia commonly affects the spine and upper limb joints, especially the elbow and shoulder. Frequently, only 1 joint is affected and usually no more than 2 or 3 (except for the small joints of the feet), in an asymmetric distribution. Acute Infectious Arthritis may develop with or without systemic symptoms (eg, fever, malaise), particularly with diabetes, and requires a high index of suspicion. Structures such as blood vessels, nerves, and the spinal cord can become compressed due to the tissue overgrowth. 