Orthopedics - Oleksa A.P. 2006

Neurogenic arthropathies
Tabetic arthropathy

In tabetic arthropathy, the knee joint and the spine are most frequently affected (in over 50% and 24% of cases, respectively), while the hip joint (17%) and other JOINTS OF THE lower extremity are involved less often.

Joints of the upper extremity are rarely affected, accounting for slightly more than 5% of cases, predominantly during the early stage of tabes dorsalis (Nestor R., 1975).

Tabetic arthropathy has an acute onset, presenting with marked joint Swelling that develops within a single day. A characteristic feature is the absence of pain in the affected joint. At the onset of the disease, the patient complains solely of joint swelling of unknown origin.

Clear manifestations of tabetic arthropathy are evident when the knee joint is involved. The joint is significantly enlarged, yet retains a normal and painless range of motion. The Skin over the knee is of normal color, thin, and occasionally shows isolated superficial venous vessels.

Local Temperature is normal. Palpation reveals a joint distended with fluid. A puncture yields a viscous, straw-yellow exudate.

At the early stage of arthropathy, X-ray Examination may reveal no destructive Changes in the joint, although the epiphyses can be hypertrophied and deformed. Routine Blood and urine tests are normal.

Due to the absence of pain and preserved joint function, patients rarely seek medical attention.

As tabetic arthropathy progresses, significant destruction of the affected joint occurs, leading to excessive mobility, often in abnormal planes, which impairs limb function despite the lack of pain. Patients occasionally report a grinding sensation (crepitus) in the swollen joint during movement.

Physical examination reveals the previously described changes. One can clearly determine painless pathological mobility within the joint, joint instability, and malalignment of the limb axis.

Radiological findings include destruction of the articular ends of the bones, diffuse Osteoporosis of the metaepiphyses, and free bone fragments within the joint cavity. Alongside these, productive bone processes are also detected.

In tabetic involvement of the hip joint, osteolysis leads to subluxations and dislocations of the Femur, accompanied by analogous destructive changes (Fig. 363).

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Fig. 363. Radiograph of the hip joint in tabetic arthropathy: osteolysis of the femoral HEAD and Neck.

Tabetic involvement of the spine typically localizes to the lumbar region, encompassing two to three vertebrae (Fig. 364). The condition has a latent course. Despite marked pathological changes in the vertebrae, radicular disorders and pain are absent. The osteolytic process affects the vertebral bodies and arches, accompanied by productive bone changes in the form of prominent bone bridges between the vertebrae. Occasionally, severe deformities and even spondylolisthesis of the affected vertebrae may occur.

The Diagnosis of tabetic arthropathy is based on the medical history, classical clinical and radiological manifestations, and particularly the absence of pain despite profound destructive joint changes. The Wassermann reaction may be either positive or negative, depending on whether the patient has received Treatment and the stage of Syphilis resolution. The patient must be managed by a venereologist.

Fig. 364. Radiograph of the spine with tabetic involvement of the L₄-L₅ vertebrae.