Resonance imparted periostitis (RIP)

Case contributed by Dr Matt Skalski

Presentation

Long-standing bilateral leg pain and swelling. History of wind farm exposure.

Patient Data

Age: 50 years
Gender: Male

Disclosure: This is our 2020 April Fools case - we'd normally prank you with it but given the COVID-19 crisis we thought we'd just reveal it straight up but still hopefully give you a little laugh. read more

X-ray

Bilateral leg

Bilateral AP lower extremity radiographs demonstrate right genu varum and degenerative narrowing of the medial tibiofemoral joint space. Bilateral sinusoidal pattern of osseous thickening and thinning involving the bilateral tibia, fibula and to a lesser degree the femur. Subtle lamellated periosteal reaction evident at some sites of thickening. The contour has a wavelength of approximately 15 cm. No intramedullary abnormality.

CT

Right leg

Volume-rendered CT of the right lower extremity demonstrating the sinusoidal pattern of osseous deformity and areas of periostitis. 

Case Discussion

Images pathognomonic of resonance imparted periostitis (RIP), in this case secondary to wind turbine exposure rather than the more common nautical wave exposure responsible for bow legged sailors. The 15 cm wavelength of undulation matches the low frequency output of modern wind turbines. 

This patient self-presented concerned he may have RIP after seeing recent reports on TV and social media. He has lived near a wind farm for over 20 years and experienced progressive bilateral leg pain over 2 to 3 years. On examination, movement and strength were normal. Hard, moderately-tender, subcutaneous undulations over his shins were palpable. Radiographs showed classic sine wave cortical deformity and active resonant periostitis.

While the prevalence of RIP has reduced dramatically over the last 100 years with changes in maritime behavior, it is now undergoing a resurgence due to the proliferation of clean energy. The deformity is most prominent in the lower limbs, supporting the theory that direct transmission of mechanical impulses via the ground is the causative agent. Milder deformity may be seen more cephalad in the skeleton due to dissipation of the oscillatory energy 1.

Case reports suggest differing osseous wavelengths depending on the types of wind turbines in use in different parts of the world. For example, British people with the disease tend to have a wavelength close to 12 cm whereas Dutch people (where the turbine association was first described) have a wavelength closer to 18 cm as their wind turbines are taller with longer blade lengths 2,3

A strong association has emerged between RIP and renal colic, with ureteric stones forming ~15cm and ~30cm from the vesicoureteric junctions; at nodes of standing waves that travel through the ureter 4. Patients have also reported an uncommon form of vertigo when supine, where they describe the room spinning in the vertical plane, rather than the more common horizontal spinning room encountered in acute ethanol poisoning.

Importantly, a social media-fueled hoax suggesting that this condition is due to Magnetic Resonance Imaging scanners has no factual basis and has led to unwarranted concern over the use of 3 T and 7 T MRI. The Radiological Action Group of Scotland (RAGS) recently launched a highly successful and entertaining video campaign dispelling any link between MRI and RIP entitled “Never gonna give you up”. 

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Case information

rID: 75482
Published: 31st Mar 2020
Last edited: 1st Apr 2020
Inclusion in quiz mode: Included
Institution: University of Southern California

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