Painful joint without fracture on X-ray, suspected bone marrow edema syndrome
Recommended: MRI affected joint is the preferred imaging study for painful joint without fracture on x-ray, suspected bone marrow edema syndrome. Diffuse marrow T2 hyperintensity / T1 hypointensity.
Recommended study
MRI affected joint
Diffuse marrow T2 hyperintensity / T1 hypointensity. Differential: transient osteoporosis, occult fracture, AVN, infection, malignancy.
If the default doesn't apply
Distinguishing transient vs AVN
MRI
Serial MRI + clinical correlation
No contrast
Watch-outs
Migratory pattern
Transient osteoporosis can migrate joint-to-joint; distinguish from inflammatory arthritis.
Pearls
- Transient osteoporosis of hip: pregnancy or middle-aged men; self-limited 6-12 months.
- AVN early: bone marrow edema without subchondral collapse; later: crescent sign + collapse.
- Complex regional pain syndrome (CRPS) can have patchy marrow edema.