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.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

References

Reza A. Ghasemi, Saleh Sadeghi, Narges Rahimee,Mohamadnaghi Tahmasebi. Technologies in the Treatment of Bone Marrow Edema Syndrome. Orthopedic Clinics article, January 2019, Volume 50, Issue 1, Pages 131–138 DOI: https://doi.org/10.1016/j.ocl.2018.08.008

Michail E. Klontzas , Aristeidis H. Zibis, Evangelia E. Vassalou, Apostolos H. Karantanas. MRI of the hip: current concepts on bone marrow oedema. Hip Int. 2017 Jul 25;27(4):329-335. doi: 10.5301/hipint.5000527. Epub 2017 May 24 DOI: https://doi.org/10.5301/hipint.5000527

Erik F Eriksen. Treatment of bone marrow lesions (bone marrow edema). Bonekey Rep. 2015; 4: 755. Published online 2015 Nov 25. doi: 10.1038/bonekey.2015.124 PMCID: PMC4662576 PMID: 26644910 DOI: https://doi.org/10.1038/bonekey.2015.124

Starr AM, Wessely MA, Albastaki U, Pierre-Jerome C, Kettner NW. Bone marrow edema: pathophysiology, differential diagnosis, and imaging.Acta Radiol. 2008 Sep;49(7):771-86. doi: 10.1080/02841850802161023 DOI: https://doi.org/10.1080/02841850802161023

Manara M, Varenna M. A clinical overview of bone marrow edema.Reumatismo. 2014 Jul 28;66(2):184-96. doi: 10.4081/reumatismo.2014.790.

Sanjeev Patel. Review Primary bone marrow oedema syndromes. Rheumatology 2014;53:785-792 doi:10.1093/rheumatology/ket324 Advance Access publication 29 September 2013 DOI: https://doi.org/10.1093/rheumatology/ket324

Vanhoenacker FM, Snoeckx A. Bone marrow edema in sports: general concepts. Eur J Radiol 2007;62:6–15. Epub 2007 DOI: https://doi.org/10.1016/j.ejrad.2007.01.013

Del Grande F, Farahani SJ, Carrino JA, Chhabra A. Bone marrow lesions: A systematic diagnostic approach. Indian J Radiol Imaging 2014;24:279-87 DOI: https://doi.org/10.4103/0971-3026.137049

Korompilias AV, Karantanas AH, Lykissas MG , Beris AE. Bone marrow edema syndrome. Skeletal Radiol. 2009 May;38(5):425-36. doi: 10.1007/s00256-008-0529-1. Epub 2008 Jul 16. DOI: https://doi.org/10.1007/s00256-008-0529-1

Marcacci M, Andriolo L, Kon E, Shabshin N, Filardo G. Aetiology and pathogenesis of bone marrow lesions and osteonecrosis of the knee. EFORT open reviews. 2016 May;1(5):219-24 DOI: https://doi.org/10.1302/2058-5241.1.000044

O'Hare A, Shortt C, Napier N, Eustace SJ. Bone marrow edema: patterns and clinical implications. Semin Musculoskelet Radiol 2006; 10: 249–57 DOI: https://doi.org/10.1055/s-2007-971996

Papadopoulos EC, Papagelopoulos PJ, Boscainos PJ, Paschaloglou D, Gandaifis ND, Kaseta M, et al. Bone marrow edema syndrome. Orthopedics 2001;24:69–73

Hofmann S, Kramer J, Breitenseher M, Pietsch M, Aigner N. The painful bone marrow edema in the knee: differential diagnosis and therapeutic possibilities. Orthopade 2006; 35: 463–477. DOI: https://doi.org/10.1007/s00132-006-0952-8

Hofmann S. The painful bone marrow edema syndrome of the hip joint. Wien Klin Wochenschr 2005; 117: 111–20 DOI: https://doi.org/10.1007/s00508-005-0322-2

González-Martín D, Herrera-Pérez M, Martín-Vélez P, Rendón-Díaz D. Prevalence of bone marrow edema in a study population with foot and/or ankle pain.Foot (Edinb). 2019 Sep;40:76-80. doi: 10.1016/j.foot.2019.04.004. Epub 2019 Apr 17 DOI: https://doi.org/10.1016/j.foot.2019.04.004

Eustace S, Keogh C, Blake M, Ward RJ, Oder PD, Dimasi M. MR imaging of bone oedema: mechanisms and interpretation. Clin Radiol 2001; 56: 4–12 DOI: https://doi.org/10.1053/crad.2000.0585

Hofmann S, Kramer J, Vakil-Adli A, Aigner N, Breitenseher M. Painful bone marrow edema of the knee: differential diagnosis and therapeutic concepts. Orthop Clin North Am 2004;35:321–33, ix DOI: https://doi.org/10.1016/j.ocl.2004.04.005

Alain Blum, Sophie Lecocq, Damien Loeuille. Bone marrow edema aids diagnosis and prognosis October 29, 2010.Volume: 26 http//diagnosticimaging.com

Thiryayi WA, Thiryayi SA, Freemont AJ. Histopathological perspective on bone marrow oedema, reactive bone change and haemorrhage. Eur J Radiol 2008; 67: 62–67 DOI: https://doi.org/10.1016/j.ejrad.2008.01.056

Alliston T, Hernandez CJ, Findlay DM, Felson DT, Kennedy OD. Bone marrow lesions in osteoarthritis: what lies beneath. Journal of Orthopaedic Research®. 2018 Jul;36(7):1818-25 DOI: https://doi.org/10.1002/jor.23844

Quack V, Betsch M, Schenker H, Beckmann J, Rath B, Lüring C and Tingart M. Pathophysiology of traumatic bone marrow edema. Unfallchirurg 2015; 118: 199-205 DOI: https://doi.org/10.1007/s00113-014-2688-y

MB Bonadio, AG Ormond Filho, CP Helito, XM Stump, MK Demange. Bone Marrow Lesion: Image, Clinical Presentation, and Treatment.Magn Reson Insights. 2017; doi: 10.1177/1178623x17703382 PMCID: PMC5428162; PMID: 28579795 DOI: https://doi.org/10.1177/1178623X17703382

Schweitzer ME, White LM. Does altered biomechanics cause marrow edema?. Radiology 1996; 198: 851–3

Seyed Alireza Mirghasemi, MD, Elly Trepman, MD, Mohammad Saleh Sadeghi, MD,Bone Marrow Edema Syndrome in the Foot and Ankle.Foot Ankle Int 2016; 37(12):1364-1373 DOI: https://doi.org/10.1177/1071100716664783

Lim W, Saifuddin A. Review article: the differential diagnosis of bone marrow edema on wrist MRI.Skeletal Radiol. 2019 Oct;48(10):1525-1539. doi: 10.1007/s00256-019-03204-1. Epub 2019 Mar 22 DOI: https://doi.org/10.1007/s00256-019-03204-1

Giannotti S, Bottai V, Dell'Osso G, Bugelli G, Celli F, Cazzella N, Guido G. Algodystrophy: complex regional pain syndrome and incomplete forms.Clin Cases Miner Bone Metab. 2016 Jan-Apr;13(1):11-4. doi: 10.11138/ccmbm/2016.13.1.011. Epub 2016 May 11 DOI: https://doi.org/10.11138/ccmbm/2016.13.1.011

Aigner N, Meizer R, Meraner D, et al. Tapping test in patients with painful bone marrow edema of the knee, Clin J Pain, 2008, vol. 24 (pg. 131-4) DOI: https://doi.org/10.1097/AJP.0b013e31815be6a5

Breitenseher MJ, Kramer J, Mayerhoefer ME, Aigner N, Hofmann S. Differential diagnosis of bone marrow edema of the knee joint. Radiologe. 2006 Jan;46(1):46-54 DOI: https://doi.org/10.1007/s00117-005-1304-0

Karantanas AH. Acute bone marrow edema of the hip: role of MR imaging. Eur Radiol 2007;17:2225–36. Epub 2007 DOI: https://doi.org/10.1007/s00330-007-0591-4

Hiroshi Ito, Takeo Matsuno and Akio Minami. Relationship Between Bone Marrow Edema and Development of Symptoms in Patients With Osteonecrosis of the Femoral Head. Musculoskeletal Imaging, Original Research; June 2006, Volume 186, Number 6 DOI: https://doi.org/10.2214/AJR.05.0086

Malizos KN, et al. Osteonecrosis of the femoral head: etiology, imaging and treatment. Eur J Radiol 2007;63(1):16-28 DOI: https://doi.org/10.1016/j.ejrad.2007.03.019

Santilli V. Guidelines, good practice and scientific evidences in rehabilitation, vol.3, cap.8, 2019, Centro Stampa Università degli studi di Roma La Sapienza.

Galer BS, Henderson J, Perander J, and Jensen MP. Course of symptoms and quality of life measurement in complex regional pain syndrome: A pilot study. J Pain Symptom Manage 2000; 20: 286–92. DOI: https://doi.org/10.1016/S0885-3924(00)00183-4

Special report: Managing reflex sympathetic dystrophy. Case Manage Advisor 2001;12:1–13.

Aronoff GM, Harden N, Stanton-Hicks M, Dorto AJ, Ensalada LH, Klimek EH, Mandel S, Williams JM; American Academy of Disability Evaluating Physicians (AADEP) position paper: complex regional pain syndrome I (RSD): impairment and disability issues.Pain Med. 2002 Sep;3(3):274-88. https://doi.org/10.1046/j.1526-4637.2002.02044.x. DOI: https://doi.org/10.1046/j.1526-4637.2002.02044.x

Simonsick EM, Kasper JD, Guralnik JM et al. Severity of upper and lower extremity functional limitation: Scale development and validation with self-report and performance-based measures of physical function. WHAS Research Group. Women's Health and Aging Study. J Gerontol B Psychol Sci Soc Sci 2001; 56: 510–9

Franchignoni F., Salaffi F. Quality of life assessment in rehabilitation medicine. Europa Medicophysica, EDIZIONI MINERVA MEDICA, 2003 December;39(4):191-8

Luis Baerga-Varela, Rafael Arias-Berrios, Shirley Grigg, Natalia M. Betances Ramírez, Juan Galloza Otero; Complex Regional Pain Syndrome part 1: essentials of assesment and diagnosis. https://now.aapmr.org, published 08/09/2012 and last updated:08/16/2016

H. Shim, J. Rose, S. Halle, and P. Shekane. Complex regional pain syndrome: a narrative review for the practising clinician. Br J Anaesth. 2019 Aug; 123(2): e424–e433. Published online 2019 May 2. doi: 10.1016/j.bja.2019.03.030 PMCID: PMC6676230. PMID: 31056241

Marinus J, Moseley GL, Birklein F, et al. Clinical features and pathophysiology of complex regional pain syndrome.Lancet Neurol 2011;10:637-48 DOI: https://doi.org/10.1016/S1474-4422(11)70106-5

Goebel A. Complex regional pain syndrome in adults. Rheumatology 2011;50:1739-50 DOI: https://doi.org/10.1093/rheumatology/ker202

Schasfoort FC, Bussmann JBJ, Stam HJ. Outcome measures for complex regional pain syndrome type I: an overview in the context of the international classification of impairments disabilities and handicaps Disability and Rehabilitation 2000 22(9):387-98 Reprinted with permission from Taylor & Francis DOI: https://doi.org/10.1080/096382800406004

Williams JM, Dorto AJ. Determination of loss of quality of life. In: Lacerte M, editor Phys Med Rehabil Clin N Am. 2002 May;13(2):333-53, ix DOI: https://doi.org/10.1016/S1047-9651(01)00004-3

Smart, K.M., Wand, B.M., and O’Connell, N.E. (2016) Physiotherapy for pain and disability in adults with complex regional pain syndrome (CRPS) types I and II (Review). Cochrane Database of Systematic Reviews, Issue 2. Art. No.: CD010853. DOI: 10.1002/14651858.CD010853.pub2. DOI: https://doi.org/10.1002/14651858.CD010853.pub2

Manara M, Varenna M. A clinical overview of bone marrow edema. Reumatismo 2014;66 (2):184-196. DOI: https://doi.org/10.4081/reumatismo.2014.790

Shuhua Kang, et al. Extracorporeal shock wave treatment can normalize painful bone marrow edema in knee osteoarthritis. Medicine 2018;97:5(e9796). http://dx.doi.org./10.1097/MD.0000000000009796

Schetzer ME, White LM. Does altered biomechanics cause marrow edema. Radiology 1996;198:851-3. DOI: https://doi.org/10.1148/radiology.198.3.8628882

Kang S, Gao F, Han J, Mao T,et al. Extracorporeal shock wave treatment can normalize painful bone marrow edema in knee osteoarthritis. A comparative historical cohort study. Medicine (Baltimore). 2018 Feb;97(5):e9796. doi: 10.1097/MD.0000000000009796. DOI: https://doi.org/10.1097/MD.0000000000009796

Bartl C, Imhoff A, Bartl R. Treatment of bone marrow edema syndrome with intravenous Ibandronate. Arch Orthop Trauma Surg 2012;132:1781-8 DOI: https://doi.org/10.1007/s00402-012-1617-1

Vaysbrot EE, Osani MC, Musetti MC, et al. Are bisphosphonate efficacious in knee osteoarthritis? A meta-analysis of randomized controlled trials. Osteoarthritis and cartilage 2018;26:154-164; http://doi.org/10.1016/j.joca.2017.11.013 DOI: https://doi.org/10.1016/j.joca.2017.11.013

Varenna M, Zucchi F, Failoni S, Becciolini A, Berruto M. Intravenous neridronate in the treatment of acute painful knee osteoarthritis: a randomized controlled study. Rheumatology Advance Access published May 20, 2015. doi:10.1093/rheumatology/kev123 DOI: https://doi.org/10.1093/rheumatology/kev123

Saviola G, Abdi-Ali L, Povino MR. Clodronate:old drug, new uses. J Biologic Regulator & Homeostatic Agents 2015;29(3):719-22

Rosa RG, Collavino K, Lakhani A, et al. Clodronate exerts an anabolic effect on articular chondrocytes mediated through the purinergic receptor pathway. Osteoarthrites & Cartilage, 2014;22(9):1327-36 DOI: https://doi.org/10.1016/j.joca.2014.07.009

Clegg DO, Reda DJ, Harris CL, et al. Glucosamine, Chondroitin Sulfate, and the two in combination for painful knee osteoarthritis. NEJM, 2006;354(8):795-808 DOI: https://doi.org/10.1056/NEJMoa052771

Siddiqui MZ. Boswellia Serrata, a potential antinflammatory agent: an overview. Indian J Pharmaceutical Science, 2011;73(3):255-61

Moore RA, Derry S, Wiffen PJ, et al. Overview review: comparative efficacy of oral ibuprofen and paracetamol (acetaminophen) across acute amd cronic pain conditions. EJP, 2015;19(9):1213-23 DOI: https://doi.org/10.1002/ejp.649

Valenti MT, Mottes M, Biotti A, et al. Clodromnate as a therapeutic strategy against osteoarthritis. Int J Mol Sci 2017;18(12):2696 DOI: https://doi.org/10.3390/ijms18122696

Hilding M, Aspenberg P. Postoperative clodronate decreases prosthetic migration: 4-years follow-up of a randomized radiostereometric study of 50 total knee patients. Acta orthopedica 2006;77:6,912-916 DOI: https://doi.org/10.1080/17453670610013213

Varenna M, Adami S, Rossini M, et al. Treatment of complex regional pain syndrome type I with neridronate: a randomized, double-blind, placebo-controlled study. Rheumatology 2013;52:534_542; doi:10.1093/rheumatology/kes312 DOI: https://doi.org/10.1093/rheumatology/kes312

Varenna M. Bisphosphonates beyond their anti-osteoclastic properties. The lesson of complex regional pain syndrome. Rheumatology 2014;53:965-967. doi:10.1093/rheumatology/ket370 DOI: https://doi.org/10.1093/rheumatology/ket370

Fast DK, Felix R, Dowse C et al. The effects of diphosphonates on the growth and glycolysis of connective tissue cells in culture. Biochem J 1978;477:83-107. DOI: https://doi.org/10.1042/bj1720097

Cecchini MG, Fleisch H. Bisphosphonates in vitro specifically inhibit, among the hematopoietic series, thedevelopment of the mouse mononuclear phagocytelineage. J Bone Miner Res 1990;5:1019-27; DOI: https://doi.org/10.1002/jbmr.5650051005

Plotkin LI, Weinstein RS, Parfitt AM et al. Prevention of osteocyte and osteoblast apoptosis by bisphosphonates and calcitonin. J Clin Invest 1999;104: 1363-74. DOI: https://doi.org/10.1172/JCI6800

Varenna M, Adami S, Sinigaglia L.Bisphosphonates in Complex Regional Pain syndrome type I: how do they work? Clinical and Experimental Rheumatology 2014.

Varenna M, Crotti C. Bisphosphonates in the treatment of complex regional pain syndrome: is bone the main player at early stage of the disease? Rheumatology International 2018. https://doi.org/10.1007/s00296-018-4101-6. DOI: https://doi.org/10.1007/s00296-018-4101-6

Published
2020-09-04
Info
Issue
Section
Reviews
Keywords:
Bone marrow edema, bisphosphonates, algodystrophy, pain.
Statistics
  • Abstract views: 409

  • PDF: 100
  • HTML: 0
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