Bone Marrow Edema Syndrome Of The Femoral Head - Tennis

HISTORY: A 57-year-old male tennis player presented with left leg pain and episodic burning in the lumbar region radiating to the left hip, noticed during training. After matches, he occasionally experienced mild lumbar discomfort, prompting a visit to his GP. Initial assessment revealed no significant swelling, but mild lumbar discomfort radiating to the left hip. The GP recommended rest and anti-inflammatory medication. PHYSICAL EXAMINATION: After resuming activity, the patient reported increasing left hip discomfort. Despite temporary relief with rest, symptoms persisted for more than three days, leading to an orthopedic consultation. The clinical exam showed no localized tenderness, and hip radiographs revealed osteoarthritic changes without fractures. Range of motion was preserved. Pain worsened during activity, rated 7-10, prompting further imaging. DIFFERENTIAL DIAGNOSIS: Intervertebral disc herniation Transient osteoporosis of the hip Hip osteonecrosis (10% of cases may be asymptomatic) Hip labral tear Osteoarthritis, grade 3-4 Bone lesions or tumors Insufficiency or stress fractures of the femoral head TESTS AND RESULTS: MRI of the hip identified bone marrow edema consistent with bone marrow edema syndrome (BMES) of the femoral head. T1-weighted spin echo images helped differentiate BMES from neoplasms, infections, cysts, or systemic osteonecrosis. FINAL/WORKING DIAGNOSIS: Bone marrow edema syndrome of the left femoral head. TREATMENT AND OUTCOMES: Initial management included rest, anti-inflammatory medication, and physiotherapy. When conservative measures failed, steroid injections and shock wave therapy were considered. Surgical options were discussed as a contingency if symptoms persist after 45 days of conservative treatment. If a follow-up MRI shows osteonecrosis or other structural issues, surgery may be necessary to restore function.