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• W2016114627 abstract "Editorials3 April 2001Edema of the Bone Marrow Can Cause Pain in Osteoarthritis and Other Diseases of Bone and JointsAlfred Jay Bollet, MDAlfred Jay Bollet, MDDr. Bollet: Sands Point, NY 11050Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-134-7-200104030-00013 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Cartilage degeneration, although fundamental to the pathogenesis of osteoarthritis, is not the site of origin of pain, the predominant symptom of osteoarthritis. Peripheral nerves generally follow the path of blood vessels, and cartilage contains no nerves or blood vessels. Pain can originate in the synovium, the joint capsule, or intra-articular ligaments, as well as in the muscles and soft tissues, which surround and move the joint in osteoarthritis.Ordinary radiographs show the effect of degeneration of joint cartilage as narrowing of the space between the surfaces of the articular bone (usually called the “joint space” or, more accurately, the “cartilage ...References1. Felson DT, Chaisson CE, Hill CL, Totterman SM, Gale ME, Skinner KM, et al . The association of bone marrow lesions with pain in knee osteoarthritis. Ann Intern Med. 2001;134:541-9. LinkGoogle Scholar2. Grampp S, Henk CB, Mostbeck GH. Overuse edema in the bone marrow of the hand: demonstration with MRI. J Comput Assist Tomogr. 1998;22:25-7. [PMID: 0009448756] CrossrefMedlineGoogle Scholar3. Wojtys EM, Beaman DN, Glover RA, Janda D. Innervation of the human knee joint by substance-P fibers. Arthroscopy. 1990;6:254-63. [PMID: 0001702291] CrossrefMedlineGoogle Scholar4. Hayes CW, Conway WF, Daniel WW. MR imaging of bone marrow edema pattern: transient osteoporosis, transient bone marrow edema syndrome, or osteonecrosis. Radiographics. 1993; 13:1001-11; discussion 1012. [PMID: 0008210586] Google Scholar5. Hofmann S, Engel A, Neuhold A, Leder K, Kramer J, Plenk H. Bone-marrow oedema syndrome and transient osteoporosis of the hip. An MRI-controlled study of treatment by core decompression. J Bone Joint Surg Br. 1993;75:210-6. [PMID: 0008444939] CrossrefMedlineGoogle Scholar6. Mattila KT, Komu ME, Dahlstrom S, Koskinen SK, Heikkila J. Medial tibial pain: a dynamic contrast-enhanced MRI study. Magn Reson Imaging. 1999;17:947-54. [PMID: 0010463643] CrossrefMedlineGoogle Scholar7. Mankad VN, Williams JP, Harpen MD, Manci E, Longenecker G, Moore RB, et al . Magnetic resonance imaging of bone marrow in sickle cell disease: clinical, hematologic, and pathologic correlations. Blood. 1990;75:274-83. [PMID: 0002294992] CrossrefMedlineGoogle Scholar8. McQueen FM, Stewart N, Crabbe J, Robinson E, Yeoman S, Tan PL, et al . Magnetic resonance imaging of the wrist in early rheumatoid arthritis reveals progression of erosions despite clinical improvement. Ann Rheum Dis. 1999;58:156-63. [PMID: 0010364913] CrossrefMedlineGoogle Scholar9. Arnoldi CC, Djurhuus JC, Heerfordt J, Karle A. Intraosseous phlebography, intraosseous pressure measurements and 99mTC-polyphosphate scintigraphy in patients with various painful conditions in the hip and knee. Acta Orthop Scand. 1980;51:19-28. [PMID: 0007376840] CrossrefMedlineGoogle Scholar10. Koo KH, Ahn IO, Kim R, Song HR, Jeong ST, Na JB, et al . Bone marrow edema and associated pain in early stage osteonecrosis of the femoral head: prospective study with serial MR images. Radiology. 1999;213:715-22. [PMID: 0010580944] CrossrefMedlineGoogle Scholar11. Lotke PA, Ecker ML, Barth P, Lonner JH. Subchondral magnetic resonance imaging changes in early osteoarthrosis associated with tibial osteonecrosis. Arthroscopy. 2000;16:76-81. [PMID: 0010627350] CrossrefMedlineGoogle Scholar12. Castro FP, Barrack RL. Core decompression and conservative treatment for avascular necrosis of the femoral head: a meta-analysis. Am J Orthop. 2000;29:187-94. [PMID: 0010746469] MedlineGoogle Scholar13. Boegard T, Rudling O, Dahlstrom J, Dirksen H, Petersson IF, Jonsson K. Bone scintigraphy in chronic knee pain: comparison with magnetic resonance imaging. Ann Rheum Dis. 1999;58:20-6. [PMID: 0010343536] CrossrefMedlineGoogle Scholar14. Dieppe P. Subchondral bone should be the main target for the treatment of pain and disease progression in osteoarthritis. Osteoarthritis Cartilage. 1999;7:325-6. [PMID: 0010329316] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Dr. Bollet: Sands Point, NY 11050Current Author Address: Dr. Bollet: 22 Plum Beach Point Road, Sands Point, NY 11050. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoThe Association of Bone Marrow Lesions with Pain in Knee Osteoarthritis David T. Felson , Christine E. Chaisson , Catherine L. Hill , Saara M.S. Totterman , M. Elon Gale , Katherine M. Skinner , Lewis Kazis , and Daniel R. Gale Metrics Cited byRenal insufficiency plays a crucial association factor in severe knee osteoarthritis-induced pain in patients with total knee replacementSelect Biomarkers on the Day of Anterior Cruciate Ligament Reconstruction Predict Poor Patient-Reported Outcomes at 2-Year Follow-Up: A Pilot StudyDiseases of Subchondral Bone 1MRI findings of subchondroplasty of the knee: a two-case reportHigh Kellgren-Lawrence Grade and Bone Marrow Lesions Predict Worsening Rates of Radiographic Joint Space Narrowing; The SEKOIA StudyBone marrow lesions can be subtyped into groups with different clinical outcomes using two magnetic resonance imaging (MRI) sequencesPre-OsteoarthritisJoint space narrowing, body mass index, and knee pain: the ROAD study (OAC1839R1)Association of knee osteoarthritis with onset and resolution of pain and physical functional disability: The ROAD studyBiologic agents in osteoarthritis: hopes and disappointmentsElevated tibiofemoral articular contact stress predicts risk for bone marrow lesions and cartilage damage at 30 monthsIncidence and risk factors for radiographic knee osteoarthritis and knee pain in Japanese men and women: A longitudinal population-based cohort studyWhat makes osteoarthritis painful? The evidence for local and central pain processingComparison of MRI-based assessment systems for osteoarthritic knees: the irregularity index system and WORMSLocal Treatment of a Painful Knee with Cortiscosteroids: The Efficacy of Intra-articular Injection Compared with Peri-articular Soft Tissue InfiltrationComment on: Bone marrow lesions in people with knee osteoarthritis predict progression of disease and joint replacement: a longitudinal study: replyBone marrow lesions in people with knee osteoarthritis predict progression of disease and joint replacement: a longitudinal studyImpact of knee and low back pain on health-related quality of life in Japanese women: the Research on Osteoarthritis Against Disability (ROAD)Objective assessments of medial osteoarthritic knee severity by MRI: new computer software to evaluate femoral condyle contoursBone marrow lesions in the knee: the clinical conundrumDetection of pain-related molecules in the subchondral bone of osteoarthritic kneesPrevalence of radiographic knee osteoarthritis and its association with knee pain in the elderly of Japanese population-based cohorts: The ROAD studyImaging the painful osteoarthritic knee joint: what have we learned?Fully automatic quantification of knee osteoarthritis severity on plain radiographsCharacterization of experimentally induced post-traumatic osteoarthritis in the medial femorotibial joint of horsesThe relationship of bone marrow edema pattern in the mandibular condyle with joint pain in patients with temporomandibular joint disorders: longitudinal study with MR imagingRegulation of calcitonin gene-related peptide and TRPV1 in a rat model of osteoarthritisComments on Beattie et al.: Abnormalities identified in the knees of asymptomatic volunteers using peripheral magnetic resonance imagingMAGNETIC RESONANCE IMAGING FINDINGS IN THE EQUINE DEEP DIGITAL FLEXOR TENDON AND DISTAL SESAMOID BONE IN ADVANCED NAVICULAR DISEASE-AN EX VIVO STUDYThe management of necrosis-associated and idiopathic bone-marrow oedema of the proximal femur by intravenous iloprostPain related behaviour in two models of osteoarthritis in the rat kneeMR imaging findings in early osteoarthritis of the kneeThe genetic contribution to muscle strength, knee pain, cartilage volume, bone size, and radiographic osteoarthritis: A sibpair studyTHE CLINICAL IMPORTANCE OF MENISCAL TEARS DEMONSTRATED BY MAGNETIC RESONANCE IMAGING IN OSTEOARTHRITIS OF THE KNEE☆ 3 April 2001Volume 134, Issue 7Page: 591-593KeywordsBoneBone marrowCartilageEdemaKneesLesionsMagnetic resonance imagingNervesOsteoarthritisSoft tissues ePublished: 3 April 2001 Issue Published: 3 April 2001 Copyright & PermissionsCopyright © 2001 by American College of Physicians. 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