Therapeutic and functional approach for the treatment of patients with bone marrow edema in Rehabilitation Medicine

  • Loredana Cavalli | cavallil.doc@gmail.com Centro Giusti, Centro ambulatoriale di recupero e riabilitazione funzionale, Firenze; Società Italiana G.U.I.D.A., per la Gestione Unificata e Interdisciplinare del Dolore muscolo-scheletrico e dell’Algodistrofia, Italy. https://orcid.org/0000-0003-4075-933X
  • Giuseppe Falcone Società Italiana G.U.I.D.A., per la Gestione Unificata e Interdisciplinare del Dolore muscolo-scheletrico e dell’Algodistrofia; SOD Riabilitazione, CTO, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy.
  • Tiziana Cavalli ASST Carlo Poma, Mantova, Italy.
  • Pietro Pasquetti ASST Carlo Poma, Mantova, Italy.

Abstract

Bone marrow edema (BME) represents an imaging finding in various diseases, and often causes pain and significant dysfunction. Although few data are available about its etiology, several hypotheses have been developed to explain the pathogenetic mechanisms of BME. Increased intravascular pressure and capillary leakage within the bone marrow would lead to nerve irritation, causing pain. Bone turnover would increase locally, due to proinflammatory molecules driven by the primary cause of BME (trauma, ischemia, arthritis, etc.). In addition to imaging findings, the clinical evaluation of a subject affected by BME should rely on an accurate functional assessment, as this condition often leads to transient disability. As regards therapeutic approaches, recent research works have reported benefits from the extracorporeal shock wave treatment (ESWT) and above all bisphosphonates. A deeper knowledge of the pathophysiological bases of the BME combined with the classic physiatric approach can allow to select the subjects affected by BME who can benefit from therapies such as bisphosphonates and ESWT, and evaluate their clinical and functional effects.

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Published
2020-09-04
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Section
Reviews
Keywords:
Bone marrow edema, bisphosphonates, algodystrophy, pain.
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How to Cite
Cavalli, L., Falcone, G., Cavalli, T., & Pasquetti, P. (2020). Therapeutic and functional approach for the treatment of patients with bone marrow edema in Rehabilitation Medicine. Beyond Rheumatology, 2(2), 43-50. https://doi.org/10.4081/br.2020.39