As Bone marrow edema syndrome (KMÖS) or Transient osteoporosis This is a temporary disease of the bones, in most cases the hip. knee and upper hocks however, can also be affected, albeit less often. A spontaneous pain in the hip is the classic leading symptom of this disease. Men are statistically affected significantly more often than Women. The disease usually occurs in both sexes middle age, i.e. between the 3rd and 5th decade of life. A diagnosis can be made based on the symptoms and by means of MRI very safe.
The causes of the primary bone marrow edema syndrome have not yet been clarified, which is called "idiopathic" referred to as.
However, it can occur secondarily as a result of other diseases.
Above all, traumatic injuries, such as bruises, play a direct role or can indirectly lead to tissue atrophy via circulatory disorders and ultimately to a BMO.
Even in the last trimester of pregnancy, BMES can occur in rare cases due to compression fractures of the lumbar spine.
X-ray examinations are with primary Bone marrow edema syndrome is usually normal, as a reduction in bone density is only visible after a loss of 40% of the usual bone substance. Only sometimes, but usually only one to two months after the onset of the symptoms, is a focal (focal) To recognize density decrease. The secondary BMES, on the other hand, can show characteristic changes in the underlying disease on X-rays. The inflammation and rheumatism values in blood tests remain negative for both forms.
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The best way to diagnose bone marrow edema with almost 100% certainty is to use an MRI scan and to distinguish it from other diseases. This shows clear bone marrow edema, i.e. the increased accumulation of tissue fluid, especially in the femoral head and femoral neck. This can also be the case in deeper regions of the thigh bone and appear as a blurred area. This image is typical of a KMÖS. Scintigraphy can also be useful in making the diagnosis. By using radioactive markers, a characteristically increased blood flow to the hip and increased activity of the bone-forming cells become visible.
The most important differential diagnosis is osteonecrosis. This is the death of bone substance as a result of an infarction (the Closure of a vessel). However, osteonecrosis can be clearly distinguished from BMES with the above-mentioned examination results.
The clinical picture of the Bone marrow edema syndrome is characterized by acute stress pain in the groin and a limping gait pattern as a result of this. The intensity of the pain usually increases over time, but in any case it will not go away completely. Pain at rest and at night usually do not occur. Also typical are Restrictions on movement in the area of the hip joints. Above all, splaying, bending the hips and rotating the thigh around its own axis are difficult.
$config[ads_text3] not foundThe aim of treating bone marrow edema is to achieve partial or total discharge the hip, as well as Freedom from pain. This is through the administration of medication like Ibuprofen or Diclofenac (to the group of NSAIDs due) and sometimes with weak opioids, such as tramadol. With the help of physical therapy can also Micro- and Compression fractures of the only slightly resilient bone can be prevented. Furthermore, the intake of Aminobisphosphates promote bone formation. These have essentially two effects on the bone. On the one hand, they are made up of cells that break down bone substance, the Osteoclasts, absorbed and inhibit their activity, on the other hand they can attach to the surface of bones and thus directly to Mineralization contribute. In contrast, the gift of Calcitonin (a endogenous hormone to build up the bone) and Cortisone not proven. Prostacyclin and structurally similar active ingredients can partly be used in off-label use, i.e. without clinically proven proof of effectiveness, and achieve a positive effect. A Drilling of the edema, as it is often done in osteonecrosis, can be done by a Pressure relief of the bone and the subsequent improvement in blood circulation lead to an immediate and significant improvement in symptoms. In each case, however, is one medicinal and physiotherapeutic Therapy of the highest priority.
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As with other musculoskeletal disorders Sports is an extremely good means of preventing bone marrow edema. By building up the muscles, a good stability of the joints and thus the risk of injuries to the bones and the chance of falls is significantly reduced. Also promotes the stress on the bone metabolism and thus the construction of the Bone substance.
$config[ads_text4] not foundA person's knee does not consist of a single bone, but should be viewed as a joint. It consists of three bones that are stabilized with the help of ligaments and muscles. Its bony parts include the thigh, the shin 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 relief of the knee joint should take depends on the healing process. Experience has shown, however, that it should last about six weeks and be replaced over the course by gradually reloading.
Bone marrow edema takes a long time because the metabolism of the bones slows down with age.
Repair processes therefore require more and more time with increasing age. It often takes about a year for bone marrow edema to heal completely.
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For athletes, this means gradually increasing performance and not doing competitive sports for at least three months.
If those affected put pressure on the joint too quickly, the bone threatens to lose stability and elasticity.
The more pressure is exerted on the bone by the accumulated fluid, the more its small blood vessels and nerves are compressed. The result is an undersupply of the bone tissue, which in the worst case shows up in the loss of the bone. Broken bones could result.
In order to avoid excessive stress, painkillers should be used in sufficient amounts but in doses. Only in extreme cases should operational measures such as a relief well be considered. They often involve unnecessary risks and do not shorten the course of the disease.
Bone marrow edema of the hip is an accumulation of fluid in the small cavities of the hip bones.
The liquid is preferably stored in the femoral head.
Further therapy depends on the cause of the disease and aims to eliminate the trigger. Complete freedom from symptoms can usually be expected after a year, but in individual cases it can be longer.
$config[ads_text2] not foundBone marrow edema of the shoulder is often the result of accidents or age-related wear and tear on the bones.
Both causes cause irritation of the bone and reactively lead to an inflammation-related accumulation of fluid in its interstices and especially in its bone marrow. The fluid helps the body heal the inflammation better.
The blood vessels become more permeable in the course of wound healing at the inflamed area and allow cells and valuable substances to migrate into the tissue so that they can take over their defense and repair functions.
The fluid in the form of bone marrow edema is therefore accumulated by the body itself. The bone is a very strong 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 when the fluid in the bone is reduced.
Protecting the shoulder is therefore essential for therapy. The relief minimizes the inflammatory stimulus and enables the fluid to be transported away again via the lymph and blood vessels.
If the person concerned were to put additional strain on their shoulder, the pressure on the bones 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 and exercising 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 partial exertion, which must be increased in steps up to full exertion.
With 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. The movement, of course, always irritates the joint and delays the healing process. Nevertheless, it is necessary in order not to retain any restrictions later.
Physiotherapy is therefore best recommended for adequate stress. It can take up to a year for complete healing.
Ankle bone marrow edema is an accumulation of fluid in one or more bones of the ankle.
The diagnosis of bone marrow edema of the lumbar spine is an accumulation of fluid in the bone marrow of one or more vertebral bodies.
There is usually no free fluid in the small spaces between the bones, so edema is always abnormal.
In the case of bone marrow edema of the cervical spine, the solid bone structure of the vertebral bodies contains fluid that can exert pressure on the surrounding structures.
If nerves or blood vessels are pinched off, this leads to the development of characteristic symptoms. Those affected 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 if the muscles harden as a result.
If loss of sensitivity such as tingling occurs, this indicates an entrapment of nerves.
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 tomography of the cervical spine then make it possible to objectify the severity and the number of affected vertebrae.
In this context, the Modic findings are also collected.
The Modic classification 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 Modic's sign.
Type II has a fat marrow instead of the blood-forming bone marrow.
And in type III the bone marrow is hardened.
Therapy will also be given depending on the cause and extent of the bone marrow edema. If the spine is stable, conservative treatment is possible.
So pain is relieved with medication and the spine is relieved as much as possible. For those affected, this means carrying or lifting as little as possible and not doing any sport. If the pain subsides, the load can slowly be increased again.
However, it often takes about a year for bone marrow edema to heal completely. However, after six weeks of consistent rest, an improvement should already be felt.
Despite extensive drug therapy and physiotherapy, patience needed when it comes to healing Bone marrow edema goes. Symptoms persist for at least 4 weeks and often up to 6 months. Even if a longer course of the illness of 12 or 18 months is also possible, a chronification of the symptoms is still not known. Whether and to what extent the bone marrow edema syndrome can be viewed as a preliminary stage of osteonecrosis is controversial.