Bone Marrow Oedema — Diagnosis and Treatment in Jaipur
Bone marrow oedema refers to an accumulation of fluid within the trabecular bone, most commonly detected as a high-signal area on MRI imaging. It is not a diagnosis in itself but rather a finding that indicates an underlying pathological process within the bone.
Common causes include subchondral bone stress from osteoarthritis, post-traumatic bone bruising, stress fractures, transient osteoporosis of the hip, avascular necrosis, and inflammatory arthritis. Identifying the underlying cause is essential for guiding appropriate treatment.
Symptoms typically include deep, aching bone pain that may worsen with weight-bearing, tenderness on palpation, and associated swelling of the overlying joint. The pain can be severe and significantly limit mobility.
Diagnosis and Treatment of Bone Marrow Oédema
MRI is the gold standard for diagnosing bone marrow oedema. Additional investigations including bone density assessment, blood tests, and CT scanning may be required to identify the underlying cause and assess for associated structural changes.
Conservative treatment is the first-line approach for most causes of bone marrow oedema:
- Protected Weight-Bearing and Activity Restriction
- Anti-Inflammatory Medications
- Bisphosphonate Therapy (for transient osteoporosis)
- Prostacyclin Infusion Therapy (Iloprost) in selected cases
- Physiotherapy for Muscle Strengthening and Joint Protection
Surgical and Interventional Treatment
In cases where conservative treatment is insufficient or where an underlying structural cause requires correction — such as avascular necrosis or subchondral fracture — surgical intervention may be considered. Core decompression, joint replacement, or treatment of the underlying arthritic joint may be appropriate depending on the clinical situation.
