yoga book / pathologie / knochenmarködemsyndrom KMÖS
Contents
Definition
Bone marrow oedema syndrome is a symptomatic bone marrow oedema, the traumatic form is referred to as bone bruise. In bone marrow oedema syndrome, increased fluid accumulates in the interstitium of the bones as part of an inflammatory reaction with osteoclast activation and increased release of inflammatory mediators. As a result, the mineralisation of the bone and thus its stability decreases. The main localisations are primarily the hip joint, less commonly the knee joint (usually the medial femoral condyle) and OSG or calcaneus. Very rarely it occurs in the shoulder joint. During pregnancy, it can also occur in the vertebral bodies, especially the lumbar spine. The progression is sometimes protracted and can sometimes lead to chronic persistent pain. Bone marrow oedema syndrome is considered to be self-limiting, but it can also progress to bone necrosis, which is a potential complication. Athletes are predisposed to this if they do not accept prolonged rest. The peak is in middle-aged men, M:W 3:1. The symptoms last at least 4 weeks under therapy, often 3-6 months, protracted courses also 12-18 months.
Cause
- traumatic (Bone bruise)
- Atraumatic ischaemic (circulatory disorders, vascular diseases)
- Atraumatic reactive, for example in arthrosis, RA, Morbus Sudeck (CRPS 1)
- Atraumatic mechanical (overloading, often in connection with trauma)
- Secondary to pregnancy („pregnancy-associated osteoporosis„)
- Possibly also unclear autoimmunological genesis
Predisposing
Diagnose
- MRT, Scintigraphy
- the X-ray is usually unremarkable, as X-rays only show higher-grade damage
Symptome
- Mostly joint-related painfulness on exertion and consecutive pain avoidance behaviour
- Rather rare rest pain
- Localised overheating if necessary
- Possibly painful restriction of movement
- Pressure sensitivity, if applicable
- possible deterioration due to night’s sleep
Complications
- Osteonecrosis with inadequate care
- Osteochondrosis dissecans
- Morbus Sudeck (CRPS)
- Secondary disorders due to relieving postures, such as joint contractures, muscle atrophy, coordination disorders
Therapie
- Prostacyclin or bisphosphonates by infusion
- Surgical drainage holes, if necessary
- Relieve the bone for at least 6 weeks, forearm crutches if necessary. No impact sports, especially no fast walking
- Anti-inflammatory drugs, analgesics if necessary
- Cooling
- Training with a resistance band or stationary bike, several times a day
- Substitution of Ca and D3 if necessary
- No studies are available for calcitonin and cortisone