Symptoms

The clinical picture of the bone marrow edema syndrome is characterized by acute stress pain in the groin area and a limping gait pattern as a consequence of this. The intensity of the pain usually increases over time, but in any case it will not completely disappear. Pain at rest and at night usually do not occur. Also typical are restrictions of movement in the area of the hip joints. Above all, straddling, bending in the hip and rotating the thigh around its own axis are more difficult.

Therapy

As with other diseases of the musculoskeletal system, sport is an exceptionally good means of preventing bone marrow edema. The build-up of muscles ensures good joint stability, thus significantly reducing the risk of bone injuries and the probability of falls. The stress on the bone also promotes its metabolism and thus the build-up of bone substance.

By localization

The knee of a human being does not consist of a single bone, but is to be regarded as a joint. It is made up of three bones that are stabilized by ligaments and muscles. The bony parts of the knee include the thigh, the shinbone and the kneecap.

If fluid accumulates in one or more bones of the knee joint, it is called bone marrow edema of the knee. How long the knee joint should be relieved depends on the healing process. Experience shows, however, that it should last about six weeks and be replaced by a gradual reloading over the course of time.

This is because bone marrow edema is very protracted, as the metabolism of the bone slows down with age. Repair processes therefore require more and more time with increasing age. It often takes about a year for a bone marrow edema to heal completely.

For athletes, this means gradually increasing their performance and not doing any competitive sports for at least three months. If those affected stress the joint too quickly, the bone threatens to lose stability and elasticity. The more pressure that is exerted on the bone by accumulated fluid, the more its small blood vessels and nerves are compressed.

The result is an undersupply of bone tissue, which in the worst case can lead to bone destruction. Bone fractures could be the result. In order to avoid a too fast load, painkillers should be used sufficiently but in a dosed manner.

Only in extreme cases should surgical measures such as a relief drilling be considered. They often involve unnecessary risks and do not shorten the course of the disease.

Cause: The cause of the accumulation of fluid in the small cavities of the bone can range from an accident to a metabolic disease and must be clarified in detail by a physician.
Symptoms: Symptomatically, affected persons feel pain in the knee area, which can be explained by the increased pressure on the bone structures.
This is because the fluid fills the small spaces between the bones and exerts an unaccustomed force on them from within. The pressure increases especially when the affected joint is loaded, when the patient’s own body weight and gravity put additional strain on the joint. Movement-dependent pain peaks are therefore typical of bone marrow edema in the knee with an otherwise inconspicuous appearance of the joint.

The fluid in the bone is not visible to the naked eye from the outside. In purely visual terms, it can therefore correspond to a healthy knee.
Therapy: The therapy always depends on the cause of the bone marrow edema, but usually includes initial protection of the affected joint. Relief with forearm crutches is completely sufficient and maintains the mobility of the joint.
The relief enables the body to get a grip on the inflammatory reaction. Movement would only mean a further irritation of all structures and reactively lead to even more fluid accumulation. Lymphatic drainage can help to drain the fluid even faster.

A bone marrow edema of the hip is an accumulation of fluid in the small cavities of the hip bones.

The liquid is deposited preferentially in the femoral head. The further therapy depends on the cause of the disease and aims to eliminate the triggers. A complete freedom from symptoms can usually be expected after one year, but in individual cases it can take longer.

Symptoms: To better understand the symptoms, it is important to know the structure of the hip joint. It consists of the thigh and the pelvis. In order for these two bones to form a joint, the thigh has a femoral head and the pelvis has a socket.
Only with a perfect fit, together with ligaments and muscles, they form an optimal joint. If fluid accumulates in the femoral head, the fluid presses on the network of its bone structures. The result is a painful inflammatory reaction in the bone itself.

If the leg or hip is not moved, it does not hurt, since there is no friction point between the hip bones in a resting position. However, if the affected person puts pressure on the leg, this leads to pain.The joint surfaces meet and the nerves in the femoral head are compressed and irritated by the pressure of the fluid and the body’s own weight. The pain often radiates into the groin and often leads to a limp.
Causes: The cause of bone marrow edema in the hip must always be determined in each individual case.
Frequently, age-related arthrosis in the hip is the trigger for the accumulation of fluid. In the same way, however, even the smallest bone fractures or metabolic diseases such as rheumatoid arthritis can trigger a bone marrow edema.
Pregnancy: If it occurs temporarily during pregnancy, doctors speak of pregnancy-associated osteoporosis. It is more common in the last third of pregnancy in first-time mothers.
The cause has not yet been clarified. However, it is suspected that there is a connection with the altered hormonal influences during pregnancy.
Therapy: In every case of bone marrow edema, immobilization is the first choice. Those affected must therefore relieve the pressure on their affected leg for at least three to six weeks with crutches and lying down phases.
In order to keep the hip joint mobile, physiotherapy should be provided after the acute phase. As the healing process progresses, it should increase in intensity and duration. Since bone marrow edema takes a very long time to heal, physiotherapy can last for months.

Painkillers can be taken to relieve the pain.

Bone marrow edema of the shoulder is often caused by accidents or age-related wear and tear of the bones. Both causes cause irritation of the bone and reactively lead to an inflammatory accumulation of fluid in its interstitial spaces and especially in its bone marrow. The fluid helps the body to better heal the inflammation.

As the wound heals, the blood vessels at the inflamed site become more permeable and allow cells and valuable substances to migrate into the tissue, enabling them to take over their defense and repair functions. The fluid in the form of bone marrow edema is thus accumulated by the body itself. Bone is a very solid tissue that cannot stretch as well as the skin.

If too much fluid accumulates in its cavities, it presses on its solid structures as well as on its blood vessels and nerves. The effect is the sensation of pain. The pain will only subside if the fluid in the bone is reduced.

Therefore, protecting the shoulder is essential for the therapy. Relief minimizes the inflammatory stimulus and allows the fluid to be transported away again via the lymphatic and blood vessels. If the affected person were to put additional strain on his shoulder, the pressure on the bone would additionally irritate the nerves and the body would try to bring even more fluid with defense cells into the inflamed area.

Carrying and lifting loads as well as sports must therefore be avoided for at least three weeks (in some cases up to six weeks). Depending on the sensitivity to pain, this is followed by a partial load, which must be increased in steps until full load is reached. In the case of the shoulder, it is very difficult to estimate when complete healing can be achieved.

In order to maintain the mobility of the joint in all degrees of freedom, it must be moved regularly. Of course, movement always irritates the joint and delays the healing process. Nevertheless, it is necessary in order not to retain any restrictions later on.

Physiotherapy is therefore best recommended to ensure adequate loading. It may well take up to a year until the joint is completely healed.

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Therapy:

Bone marrow edema of the ankle is an accumulation of fluid in one or more bones of the ankle.

Causes: Often the cause is a trauma, which often happens during sports. The irritation of bone structures can occur either suddenly due to incorrect loading or permanently due to overloading. So if someone bends over, he can just as easily develop bone marrow edema as if he overstrained the bones by running for days on end.
But metabolic diseases, medication or a disturbed blood circulation in the ankle area can also cause bone marrow edema in the ankle.
Symptoms: The symptoms are always comparable and show themselves mainly through pain in the ankle joint. The ankle may be initially swollen by the trauma, although swelling is not a characteristic sign of bone marrow edema.It is much more typical that affected persons feel pain without any external cause. The pain occurs especially under stress and increases in intensity.
Depending on the location of the bone marrow edema, the pain can also extend into the foot or shin.
Therapy: Normally, immobilization of the ankle joint is sufficient to heal the bone marrow edema. Patients are often initially given forearm crutches for complete relief and then a splint or roll-over aid for partial weight bearing. The downside is that this treatment method can take up to a year.
However, it is also the safest and least complicated, as it does not involve any surgical intervention. Surgery is only necessary in rare cases of bone marrow edema. If the pressure exerted on the bone by the fluid is too strong and the bone is in danger of breaking, a relief drill can be performed.

The fluid can drain through the drilled hole and the pain subsides. Nevertheless, after such an operation the ankle joint must be relieved and the course of the disease is not shortened. It only protects against bone loss in an emergency.

The procedure itself does not take long if no other structures such as muscles or ligaments have to be corrected by trauma in the same operation.

The diagnosis of a bone marrow edema of the lumbar spine is an accumulation of fluid in the bone marrow of one or more vertebral bodies. Normally there is no free fluid in the small spaces between the bones, so edema is always abnormal.

Causes: The cause can be manifold.
Frequently, it is trauma, which leads to a bruise of the spine. Metabolic diseases such as those of the rheumatic form or age-related signs of wear and tear can also lead to bone marrow edema of the lumbar spine.
Diagnostics: It is important to find out how many vertebral bodies are affected by edema and whether the stability of the spine is given. It is not uncommon for bone marrow edema to occur as a result of shifts or malpositions of the vertebral bodies.
Imaging in the form of magnetic resonance imaging of the lumbar spine provides information about the extent and severity. The treating physician then uses imaging to classify the bone marrow changes into different types. The common classification according to Modic distinguishes three types.

Type I stands for bone marrow edema. Sometimes it is also indicated as a Modic sign. In type II, the haematopoietic bone marrow is replaced by fat marrow and type III stands for a hardened bone marrow.
Therapy: The treatment depends on the cause and change of the bone marrow edema.
In principle, however, there is always an adequate pain therapy, which should be accompanied by a sparing of the spinal column. Consequently, lifting and carrying heavy objects and even sports should be avoided. Depending on the degree of severity, surgery may even be necessary to restore the stability of the spine.

If back pain or loss of sensitivity occurs in addition to back pain, this indicates that nerves are trapped, which must be repaired as quickly as possible by surgery.

In the case of bone marrow edema of the cervical spine, the vertebral bodies contain fluid in their solid bone network, which can exert pressure on surrounding structures. If nerves or blood vessels are squeezed, this leads to the development of the characteristic symptoms. Affected persons feel bone marrow edema of the cervical spine mainly through pain in the neck area, which can even radiate into the shoulder.

But headaches can also occur when the muscles harden as a result. If sensory deficits such as tingling occur, this indicates that nerves are being pinched. There are many causes that can lead to bone marrow edema.

The trigger must always be found individually. Quite often, however, it is trauma or rheumatic diseases that lead to bone marrow edema. To confirm the suspected diagnosis, a doctor will request an imaging of the spine.

The images of the magnetic resonance imaging of the cervical spine then make it possible to objectify the severity and number of affected vertebrae. The findings according to Modic are also collected within this framework. The classification according to Modic divides bone marrow changes in the area of the vertebral bodies into three types.

Type I stands for bone marrow edema and can also be referred to as a Modic sign. Type II is a fatty marrow instead of the haematopoietic bone marrow. And in type III the bone marrow is hardened.

Depending on the cause and extent of the bone marrow edema, therapy will also be given.If the spine is stable, conservative treatment is possible. Pain is thus relieved by medication and the spine is relieved as much as possible. For those affected, this means wearing or lifting as little as possible and not doing any sports.

If the pain subsides, the load can be slowly increased again. However, it often takes about a year for a bone marrow edema to heal completely. After six weeks of consistent protection, however, an improvement should already be noticeable.

Symptoms:
Causes
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