Bone Marrow Edema: Not just your usual swelling

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Bone-marrow-edema

Bone marrow Edema refers to the condition of excessive fluids build-up in the bone marrow thereby causing swelling in the region. Bone Marrow Edema is often caused as a counter-reaction either to an injury, such as a broken bone or a bruise, or a more chronic condition such as osteoporosis. Bone marrow Edema most commonly occurs in the hips, ankles or Knees. Sometimes it’s very tricky to pinpoint or self-diagnosed yourself with Bone marrow Edema’s for it may not bother you at all, or it might be painful and inconvenient like some injury. Sometimes Bone Marrow Edema can also surface as a muscular injury like a bruise or so because of the nature of the bone and thus can feel a little more intense. However, unlike muscles bones are not capable of swelling, and thus the fluid (Edema) that gets accumulated in the marrow creates intense pressure within the bone, thereby resulting in more intense pain. And, in many osteoarthritic patients, the excruciating pain they experience isn’t due to the lack of cartilage, but because of the pressure intensity by the accumulated Edema.

Symptoms of Bone Marrow Edema are:

  • Mild to moderate degrees of pain.
  • Swelling in the Knee area.
  • Inability to walk without support.
  • Recurrent tenderness and pain.

Symptoms of Bone marrow Edema of the knee includes localized knee and joint pain, and can only be diagnosed through a Magnetic Resonance Imaging (MRI). Following is a list of possible symptoms of Bone Marrow Edema:

  • Knee Bone trauma such as broken bones and bone bruises.
  • Joint disorders like osteoarthritis or osteoporosis. In the case of osteoarthritis or osteoporosis, the Knee Joint lacks the cushion provided by the cartilage that can lead to fracture and wear on the bone rather easily. And thus the fractured or injured area of the bone becomes susceptible to Edema.
  • “Bone death” or Avascular necrosis. It refers to a condition when a small area of the bone dies, resulting in a painful Bone Marrow Edema.
  • Knee ligament injuries or Bone Tumor.
  • Inflammation in the synovial membranes, present in the lining of the Joints called synovitis. 

Treatment of Bone Marrow Edema in Knee:

Treatment-of-Bone-Marrow-Edema-in-Knee

Fortunately, Bone Marrow Edema’s mostly settle down and heal on their own once the injury subsides. And in some cases of Osteonecrosis, the bone regenerates itself and heal the Edema on its own just like a common injury. However, unfortunately, that’s not the case in Osteoarthritis and the Edema only get worse over time. In such circumstance, there are many treatment courses and options that you may resort to.

The traditional treatment of Bone Marrow Edema includes rehabilitation through physiotherapy and rest. Ice, Painkiller medications such as ibuprofen or acetaminophen, and even a crutch or a cane to assist in walking. Other treatments are drug-facilitated treatment with the use of bisphosphonate and vitamin D composition to increase bone density and is found to be quite effective in relieving pain and increasing density of the bones. Drug Facilitated treatments are intravenous and are administered by injecting the composition in the veins of the patient. Drugs used to treat the vascular system have been found to be effective to counter Bone Marrow Edema because of their property to facilitate more blood flow which can easily cure any vascular abnormalities that may arise in the bone and marrow as a symptom of Bone Marrow Edema.

Well, that was in case if Bone Marrow Edema has been caught early. But what about those cases which have been diagnosed late? For such challenging cases, Core Decompression is used. Core Decompression is a kind of surgery in which a surgeon drills a hole into the affected part of the bone to increased blood flow in that area, thereby encouraging the formation of new blood vessels and healing process.

Another such surgical option is Subchondroplasty. Subchondroplasty is especially effective for Osteoarthritis patients because it’s done to improve the strength of the bone, thereby increasing the tolerance level of the bone, which will enable it to deal with the pain of the Edema and that of Osteoarthritis. In Subchondroplasty, an x-ray is taken to pinpoint the Edema affected area. After which, the patient is sedated to inject a small needle comprising of a special paste into the Edema affected area. The injected paste hardens the bone providing more strength and density to it.

Bone Marrow Edema in Foot:

Bone marrow Edema syndrome (BMES) of the foot and ankle is a rather uncommon medical condition and there isn’t any record of the same in any Orthopaedic literature. Recent studies have shown this musculoskeletal disorder is associated with transient Osteoporosis of the Hip and Regional Migratory Osteoporosis and can have a varying effect on the body thereby increasing the risks factors. Bone Marrow Edema Syndrome is often caused due to a deficiency in Vitamin D in the body but the cause of Bone Marrow Edema in Foot and Ankle is still shrouded in mystery.

Is Bone Marrow Edema something to be serious about?

The development of Bone Marrow Edema in Osteoarthritis is usually a sign of a worsening condition as the risks of formation of Subchondral cysts can often be spotted on an MRI in addition to the accumulation of excessive fluid in the bone. 

Subchondral cysts are fluid-filled sacs (cysts) and occur when more damage is done to the Cartilage which then begins to harden and form Subchondral cysts. Formation of such Cysts narrows the space between the joints and causes the cartilage to further wear away, thereby allowing more interactions between bones and rubbing between them.

As more and more cartilage is lost, the underlying nerve receptors become increasingly exposed, leading to excruciating pain and increase risks of mobility loss, especially in the case of Knee Osteoarthritis. An underlying knee misalignment will only worsen the condition for it induces more structural stress to already inflamed joints.

Bone Marrow Edema with osteoarthritis is associated with poor outcomes as compared to Osteoarthritis without Edema. Reason? Because Osteoarthritis patients’ condition associated with Edema deteriorate far more quickly over the course of 15 to 30 months than those without Edema.

Bone Marrow Edema in Injury:

Bone-Marrow-Edema-in-Injury

Commonly, Bone marrow Edema is seen with fractures and other serious bone or joint injuries, involving the spine, hip, knees, or ankle especially. Bone Marrow Edema associated with Injury might lead to accumulation of fluid, blood or build-up of fluids due to fibrosis (scarred tissue) or necrosis (tissue death). Below is a list of causes of Bone Marrow Edema associated with Injuries the spine, hip, knees, or ankle: 

  • Traumatic Fractures of the foot, hip, ankle, or knee, resulting in repetitive impact and undue strain on a weight-bearing joint. 
  • Anterior Cruciate Ligament (ACL) Tears. Vertebral Compression Fractures, a condition in which the bones of the spine starts to crumble and collapse. Such fractures are often associated with older and advanced age. 
  • Bone Tumors, refers to a condition in which the accumulation of fluid can erode the structural integrity of a bone, thereby increasing the risk of a fracture. Although, Bone Tumor is rare and doesn’t occur frequently, but the possibility cannot be undermined. 
  • Osteomyelitis or bone infection. 
  • Hip Dislocation resulting in Bone death.

Although, Bone Marrow Edema treatment can vary as per the condition and causes Edema associated with traumatic injury or repetitive motion can be commonly healed with rest, Nonsteroidal Painkillers and physical therapy. Severe cases such as Bone Tumors and Osteomyelitis might require surgery or steroid injections. 

Bone Marrow Edema affects people differently and can be a confusing condition. But Bone Marrow Edema associated with traumatic or stress fractures and injuries can be easily healed within a period of four to 12 months. And if not so, there’s only a 15 per cent of cases those treatments might be prolonged to two years or more depending on their case, even among those in perfect health.

Conclusion:

Edema or swelling can indicate where the pain started and how strong your bones are, which can affect the treatment course. But if your doctor tells you that you have Bone Marrow Edema, make sure to ask the cause and recommended treatment course. Bone Marrow Edema most commonly occurs in the Hips, Ankles or Knees. Sometimes it’s very tricky to pinpoint or self-diagnosed yourself with Bone marrow Edema, for it may not bother you at all, or it might be painful and inconvenient like some injury. Therefore making the detection of Bone Marrow Edema all the more important, especially in managing the symptoms of arthritis, stress fracture, cancer, or infection. For if Edema once deteriorates, the risks of you losing your ability to walk also rises. However, if diagnosed with it, your doctor will tell you the time, therapy and pain medication along with the treatment course to follow to heal it.

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