Case 14: Intramedullary Osteosclerosis

Orthopaedic Case of the Month: Lower Leg Pain in a 41-year-old Woman

“…Furthermore, it shows no familial effect and no relationship with infection, trauma, or systemic illness. Laboratory findings are typically normal [1,2,5]. Some studies suggests absence of an hereditary pattern, female predominance, mechanical pain, and absence of periosteal hyperostosis favor intramedullary osteosclerosis [2,5].…”

“…Laboratory findings are typically normal [1,2,5]. Some studies suggests absence of an hereditary pattern, female predominance, mechanical pain, and absence of periosteal hyperostosis favor intramedullary osteosclerosis [2,5]. However, several other studies suggest these differential points are not diagnostically useful in many cases [9,12,17].…”

“…The presence or absence of associated reactive marrow edema can be used to distinguish intramedullary sclerosis from Ribbing disease. Whereas intramedullary sclerosis is characterized chiefly by increased bone density, Ribbing disease usually shows edema and enhancement on T2-weighted and postgadolinium T1-weighted MR images, respectively, in the adjacent marrow and surrounding soft tissues [2,5,9,12,17].…”

“…The tibia and femur usually are involved, but it also affects the fibula, radius, and ulna. The disease is asymmetric or asynchronous bilateral, and is suspected to show an autosomal recessive trait [2,17,19]. It occurs after puberty and is more common in females [19].…”

“…The typical presenting symptom is bone pain [3], which may be associated with swelling [17,18]. Furthermore, the pain appears to be resistant to medication [2,18], and to be associated with physical activity [12]. In the absence of specific treatment, it can resolve spontaneously with time or progress [9,12].…”