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Focal Bone Marrow Lesions: A Complication of Ultrasound Diathermy
Clin Should Elbow 2019;22:40-45
Published online March 1, 2019;  https://doi.org/10.5397/cise.2019.22.1.40
© 2019 Korean Shoulder and Elbow Society.

Seung Jae J. Kim, Yusuhn Kang1, Dae Ha Kim2, Jae Young Lim3, Joo Hyun Park, Joo Han Oh

Departments of Orthopedic Surgery and 1Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, 2Department of Orthopedics and Sports Medicine, CM General Hospital, Seoul, 3Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
Correspondence to: Joo Han Oh
Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea
Tel: +82-31-787-7197, Fax: +82-31-787-4056, E-mail: ohjh1@snu.ac.kr, ORCID: https://orcid.org/0000-0002-4962-3175
IRB approval: Seoul National University Bundang Hospital (No. B-1808-487-701).
Received August 31, 2018; Revised September 29, 2018; Accepted October 16, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
Ultrasound diathermy is widely used for the treatment of musculoskeletal disorders and other soft tissue injuries. Its use as a therapeutic
modality is believed to be safe, with very few reported complications. Here, we report two patients who developed focal bone marrow abnormalities after receiving ultrasound diathermy. Both patients magnetic resonance (MR) evaluations revealed linear subchondral bone lesions of the superolateral humeral head similar to those in osteonecrosis. The patients symptoms subsequently improved, and
available follow-up MR evaluation revealed near complete resolution of bone lesions. These findings suggest that ultrasound diathermy,
and its interaction with bone tissue through thermal mechanisms, can cause focal bone marrow abnormalities. Furthermore, the bone marrow abnormalities seem to be transient, resolving upon cessation of ultrasound diathermy, therefore osteonecrosis should be differentiated from this temporal lesion.
Keywords : Osteonecrosis; Magnetic resonance imaging; Complications; Diathermy