Case presentation and intervention: A 49-year-old male self-employed carpenter presented to the chiropractic clinic complaining of increasing pain in the right foot and ankle region. Initially a visit to the general practitioner had resulted in analgesic prescription. Due to the continuation of the pain, MRI of the involved foot was obtained. Extensive bone marrow edema was noted, but without explanation as to the etiology. The etiology was established on further questioning as being linked to the use of the new carpentry equipment, which the patient demonstrated. Chiropractic management was provided for the patient including advice regarding the equipment use.
Results: MRI performed after 8 weeks demonstrated a reduction in the amount of bone marrow edema. In addition, the patient reported a reduction in the level of pain using the visual analogue scale and an increase in the range of movement of the foot.
Discussion:Bone marrow edema may be due to a variety of clinical disorders resulting in hyperemia, such as trauma, disuse, transient and migratory osteoporosis, complex regional pain syndrome and osteonecrosis. Physical examination of the patient is often unrewarding and may be aided by the use of imaging. MRI demonstrates the findings of bone marrow edema exquisitely on the fluid sensitive sequences, particularly the short tau inversion recovery (STIR) sequence. Bone marrow edema is demonstrated on MR imaging as intermediate signal on T1-weighted images, and increased signal intensity on the T2-weighted sequence. MRI may be used to follow the response of patients. In this case it was possible to see the gradual resolution of the edema, which correlated with the reduction in pain.
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