Charcot's Joint


Examine this patient's joints.

Examine the locomotor system in this patient.



· History of diabetes (Medicine 1972; 51:191 210).

· Gait deformity.

· Loss of pain threshold.

· Atrophy of muscles of the joint.


· 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.

Proceed as follows:

· Check sensation in the affected limb.

· Tell the examiner that you would like to investigate as follows:

-Do a thorough neurological examination, looking for loss of proprioception,

and/or pain sensation, and vibratory sensation with a 128 Hz tuning fork.

- Examine the urine for sugar (looking for evidence of diabetes mellitus).

-Ask for lancinating pains, check posterior column signs and look for Argyll

Robertson pupil (tabes dorsalis).

-Check for dissociated sensory loss (syringomyelia).

-Test muscle strength.


This patient has Charcot's joint (lesion) due to diabetes mellitus (aetiology) and has marked deformity of the joint with restricted

movement (functional status).


What do you understand by the term 'Charcot's joint'?

It is a chronic progressive degenerative arthropathy resulting from a disturbance in the sensory innervation of the affected joint. It is a neuropathic arthropathy which represents a complication of various disorders affecting the nervous system. It results in gross deformity, osteoarthrosis and new bone formation from repeated trauma.

Mention a few conditions responsible for the development of Charcot's joints.

· Diabetic neuropathy - affecting tarsal joints, tarsometatarsal, metatarso-phalangeal joints.

· Tabes dorsalis - affecting knee, hip, ankle, lumbar and lower dorsal vertebrae.

· Syringomyelia - affecting shoulder, elbow, cervical vertebra.

· Myelomeningocele - affecting ankle, tarsus.

· Miscellaneous: hereditary sensory neuropathies, peripheral nerve injury, congenital insensitivity to pain, leprosy.

Jean Martin Charcot (1825-1893) was a French neurologist. He was a Professor of Pathology in 1872 and Professor of Nervous Diseases in 1882. The other conditions that bear his name include the following: Charcot's fever (intermittent fever due to cholangitis), Charcot's triad (intention tremor, nystagmus and scanning speech in multiple sclerosis), Charcot-Leyden crystals (seen in the sputum of asthmatics), Charcot-Marie-Tooth disease (peroneal muscular atrophy), Charcot-Wilbrand syndrome (visual agnosia).