Neuropathic osteoarthropathy: Diagnostic dilemmas and differential diagnosis

The purpose of this pictorial essay is to illustrate the radiologic spectru m of imaging findings of neuropathic osteoarthropathy. Typical findings inc lude 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 a re shown. The two prevailing theories for the pathophysiology of neuropathi c bone and joint disease, the neurovascular and neurotraumatic theories, ar e briefly described. Examples of osteoarthropathy from diverse causes are p resented including syringomyelia, spinal cord injury, meningomyelocele, dia betes mellitus, congenital insensitivity to pain, steroid injections, syphi lis, leprosy, and others. The discussion focuses on key imaging features wi th emphasis on disease patterns and differential diagnosis, which vary by s keletal location.