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Are taken in examination the various causes of the neurogenic arthropathy. Are described the three main diseases which provoke a neurogenic arthropathy, that is the tabes, the hydrosyringomyelia, the diabetic neuritis. Are described arthropathy above all on the shoulder, on the Knee, and on the Foot. Are described five points for the precocious diagnosis of the disease.
The authors describe the typical radiographic aspects of neurogenic arthropathy based on an examination of 127 cases observed at the Rizzoli Orthopaedic Institute. Surgical indications for the various joints affected are discussed, and the results obtained after treatment are reported.
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Neurological affections responsible for secondary arthropathic pathology are: tabes, syringomyelia, diabetes mellitus, congenital insensitivity to pain syndrome, alcoholism, leprosy. Each of the affections shows predilection for specific joints: syringomyelia the shoulder, tabes the hip and knee, diabetes mellitus the foot, congenital insensitivity to pain the lower limb, alcoholism the shoulder and knee. The authors discuss two cases of hip arthropathy in previous dorsal myelic fractures.
"Neurotraumatic" and "neurovascular" theories are still debated as a basis for the pathogenesis of neurogenic arthropathy. The observations of pathologic features described in the present study lead to the conclusion that both mechanisms, loss of deep sensation and neurovascular reflex inducing increased blood flow and active bone resorption, may contribute to the development of complete joint disorganization.
A number of locally defined as well as generalised diseases of the peripheral nervous system is manifested in the shoulderarm region besides lesions of individual nerves through traumas or as a result of pressure. Radicular syndromes are particularly frequent. These are based on prolapsed disks or degenerative changes of the cervical vertebral column. We must differentiate between these syndromes and the often rather unknown neuralgic amytrophy of the shoulder. Our experience has shown that in too many cases, paralysis of the plexus cervico-brachialis is assumed, although this occurs almost exclusively on the basis of traumatic violence, much rarer due to pressure. In such cases, the physician should look for the scalenus syndrome, the costoclavicular syndrome, and the hyperabduction syndrome. As a rule, pain is the most prominent symptom in plexus pareses through new growths, eg Pancoast's tumour. In such cases, a clear distinction must be made against bursitis of the shoulder (periarthritis humeroscapularis), in which there are no neurogenic changes, but only myogenic changes manifested in the electromyogram. If the sudden pain is accompanied by swelling and weakness of the arm, there is every likelihood of the existence of Paget-von Schrötter's syndrome. A remarkably painless deformation of the shoulder joint should also suggest neurogenic arthropathy in syringomyelia. The physician should also consider disturbances of distant origin, for example in the region of the carpal tunnel, with pain radiating to the shoulder in the manner of brachialgia paraesthetica. Finally, any noticeable weakness or muscular atrophy in the shoulder region should suggest a disease of the neuromuscular system, mainly progressive muscular dystrophy or the rare shoulder girdle type of amyotrophic lateral sclerosis.
Recognised forms of neurogenic osteo-arthropathy, their aetiology and pathogenesis are reviewed. Seven unusual cases are presented. Chronic alcoholism was a possible pathogenetic factors in these cases of neurogenic osteo-arthropathy from persistant drunkeness and not osteo-arthropathy occurring in alcoholics. Thus a new clinical entity is proposed.
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On the basis of 5 cases the syndrome of post traumatic arthropathy is described. Like its other forms it shows radiographyically a high degree of osteolysis, fragmentation and para-articular calcification of soft parts. The picture is similar to that of syringomyelia and tabes. If trauma occurs in childhood there will also be developmental retardation. One has to assume that trauma may be responsible for these isolated arthropathies at its site. Since the further course corresponds to that of a neurogenous arthropathie it is likely that in these cases there is an underlying disturbance of the relationship between nervous system and bone and joint which, so far, cannot be proved clinically.
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Neurogenic disorders of the foot in diabetics have been found with increasing frequency in recent years, Therefore, familiarity with the spectrum of roentgen findings appears essential. Significant changes include Charcot joints of the tarsus (destructive type), and bone absorption of the forefoot (multilating type). Charcot joints have been observed in 11 patients, bone absorption in 12, and a combination of both types in 3. This combination strongly suggests a diabetic neuropathy. Pathogenesis and differential diagnosis are briefly discussed.
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28 patients, who were suffering of tabique alterations of joints, the time between infection and the first localisations and therapy are discussed. The differential diagnosis, as far as it is interesting the orthopadien physican, is explained.