Bilateral bone marrow edema syndrome of the humeral head mimicking avascular necrosis: a case report

Abstract Background Bone marrow edema syndrome (BMES), previously referred to as transient osteoporosis, is an uncommon and underdiagnosed self-limiting condition typically affecting the weight-bearing joints of hip lower limb. Its occurrence in upper limb or non-weight bearing particularly rare. Case presentation We report case otherwise healthy 42-year-old man who gradually developed severe disabling left shoulder pain over course 6 months. Nine months after onset, he presented clinically with bilateral involvement radiologically (magnetic resonance imaging, MRI) diffuse BME associated a subchondral insufficiency fracture, suggestive proximal humeral avascular necrosis. Clinical evidence subacromial impingement MRI findings bursitis tenosynovitis effusion biceps tendons likely resulted from primary BME, musculoskeletal sonography confirmed absence rotator cuff tears. Repeated at 2, 12, 18 documented near complete resolution both consistent BMES humerus. During this time, patient reported gradual improvement symptoms range motion. The clinical picture insidious pain, exacerbated by activity improved load relief, predisposing factors for osteonecrosis antecedent trauma patients middle age, should indicate possibility diagnosis BMES. Conclusions This unprecedented documents rare head mimicking correct within atypical anatomical location avoids invasive measures affected bone. misdiagnosis secondary idiopathic can be avoided recognizing characteristics fractures tears, well their evolution on serial MRI.