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Neuropathic Osteoarthropathy: Diagnostic Dilemmas and Differential Diagnosis¹

¹ From the Department of Radiology, Medical College of Virginia of Virginia Commonwealth University, 401 N 12th St, PO Box 980615, Richmond, VA 23298-0615. Presented as a scientific exhibit at the 1999 RSNA scientific assembly. Received February 16, 2000; revision requested April 12 and received May 8; accepted May 12. Address correspondence to E.A.J. (e-mail:bethanne@firstworld.net).

The purpose of this pictorial essay is to illustrate the radiologic spectrum of imaging findings of neuropathic osteoarthropathy. Typical findings include joint destruction, disorganization, and effusion with osseous debris. A variety of other imaging findings related to neuropathic osteoarthropathy such as resorption of the ends of tubular bones and neuropathic fracture are shown. The two prevailing theories for the pathophysiology of neuropathic bone and joint disease, the neurovascular and neurotraumatic theories, are briefly described. Examples of osteoarthropathy from diverse causes are presented including syringomyelia, spinal cord injury, meningomyelocele, diabetes mellitus, congenital insensitivity to pain, steroid injections, syphilis, leprosy, and others. The discussion focuses on key imaging features with emphasis on disease patterns and differential diagnosis, which vary by skeletal location.

Index Terms: Bones, neuropathic disorder, 40.821

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