Bursitis, adventitious bursa, localized soft-tissue inflammation, and bone marrow edema in tibial stumps: the contribution of magnetic resonance imaging to the diagnosis and management of mechanical stress complications.
OBJECTIVE
To assess the contribution of magnetic resonance imaging (MRI) in the diagnosis of tibial stump bursitis, in the establishment of differential diagnosis, and in the therapeutic management prosthetic-stump interface, mainly by adaptation of the prosthetic device.


METHODS
Two-year, prospective, consecutive series.


METHODS
University-affiliated prosthetic and rehabilitation center and university department of radiology.


METHODS
A group of 17 persons with stump problems identified from a total of 139 consecutive below-knee amputees with prosthesis problems.


METHODS
Not applicable.


METHODS
Clinical symptoms and MRI.


RESULTS
Clinical symptoms (variable stump volume, fluctuating mass at palpation with or without mechanical pain) were suggestive of bursitis in 10 patients. MRI confirmed bursitis in 9 and identified 1 in whom clinical signs suggested neuroma, giving an incidence of 10 of 139 amputees (7.2%). MRI identified 13 sites of bursitis (adventitious bursa, 11; synovial bursitis, 2) and 5 localized areas of soft tissue inflammation. MRI showed diffuse muscular edema at 1 site of clinically suspected bursitis, and bursitis at another site of suspected neuroma. Calcified bursitis was observed in 1 case. Bone abnormalities associated with bursitis (n=7) included osteophytes or fracture (n=4) or bone marrow edema (n=3). Two asymptomatic neuromas were also identified. MRI-guided modifications of the prosthetic interface led to favorable outcome in all cases.


CONCLUSIONS
Bursitis, adventitious bursae, and areas of localized soft-tissue inflammation are different aspects of the same disorder resulting from a mechanical conflict between the stump and the prosthesis socket. Besides contributing to diagnosis, MRI provides a precise assessment necessary for correcting the prosthesis-stump interface in a way that reduces mechanical stress and subsequently cures bursitis.
Regional Institute of Physical Medicine and Rehabilitation, Nancy, France.
Anne
A
Foisneau-Lottin
Noël
N
Martinet
Philippe
P
Henrot
Jean
J
Paysant
Alain
A
Blum
Jean-Marie
JM
André
D000293:Adolescent; D000328:Adult; D000368:Aged; D000672:Amputation Stumps; D001186:Artificial Limbs / Q000009:adverse effects*; D002062:Bursitis / Q000175:diagnosis* / Q000209:etiology* / Q000517:prevention & control; D003240:Connective Tissue Diseases / Q000175:diagnosis* / Q000209:etiology* / Q000517:prevention & control; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007249:Inflammation; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017755:Prosthesis Fitting / Q000379:methods; D012307:Risk Factors; D013314:Stress, Mechanical; D013977:Tibia