Subchondral Sclerosis And Sclerosis Bone Lesions

Written by: Breanna Santoso, OMS-II

Are you feeling a deep ache in your joints when you move, or even if there’s no activity at all? If so, it’s possible that subchondral sclerosis (Scl) and/or sclerosis bone lesions may be the cause of your discomfort. 

In this blog post, we’ll discuss what these conditions are, provide a closer look at Scl and additional types of sclerosis, and talk about effective treatments to help manage symptoms associated with both. 

Whether this is something that just recently started affecting you or has been an issue for quite some time, seeking treatment sooner rather than later is essential for proper management. At OrthoNeuro, our medical experts are on hand to offer diagnosis and treatment of various causes of joint pain. Book now at one of our locations in Columbus, Ohio.

A man with sclerosis bone legions that are causing hip pain.

What is Subchondral Sclerosis?

Subchondral sclerosis is the thickening of the bone below the cartilage zone of joints. It most commonly affects the knee, hip, spine, and ankle joints. “Subchondral” translates to “below the cartilage” and “sclerosis” refers to abnormal hardening of tissue. 

This condition forms as a result of a compressive load on the joint in patients with later stages of osteoarthritis (OA), a degenerative condition. It may be incidentally found on x-rays and usually occurs after cartilage loss has occurred.

Subchondral sclerosis is not a diagnosis itself, but rather a radiological sign due to an underlying condition. Although it is not always present with osteoarthritis, this exam finding can help diagnose osteoarthritis and rule out similar conditions, such as rheumatoid arthritis. 

Sclerotic bone lesions may be benign or malignant, so it may be necessary to receive a thorough assessment by a physician.

Symptoms and Causes

Osteoarthritis most commonly occurs in the spine, hands, hips, and knees. As the cartilage deteriorates, the patient is at risk of developing sclerosis, which doubles the likelihood of developing symptoms. The severity of symptoms may depend on the size or location of the thickened bone.

Symptoms include:

  • Unexplained joint pain that worsens over time, at night, or after weight-bearing activities
  • Pain with the first few steps from rest that improves after moving for a little while and then gets worse again with continued activity
  • Stiffness and reduced range of motion
  • Crepitus (grinding sounds or sensations) in the joints
  • Enlargement or swelling of the joint caused by osteophytes (bone spurs)

Risk Factors

Several factors can increase one’s risk of developing osteoarthritis, which may progress to cause subchondral sclerosis.

Risk factors for osteoarthritis:

  • Female
  • Elderly
  • Obesity
  • Anatomical factors
  • Muscle weakness
  • Past joint injury
  • Family history

When to See a Doctor

Contact your doctor if you experience joint symptoms that interfere with daily activities, don’t improve with home treatment, or recur several times a month. Your primary care physician will be able to diagnose osteoarthritis in its early stages. 

As the disease progresses, they may refer you to an orthopedic surgeon who can help manage the symptoms with medical and surgical treatments.

Diagnosis and Treatment

Since subchondral sclerosis is a radiological finding rather than a diagnosis, symptomatic osteoarthritis is the condition that is treated when it impairs daily activities and quality of life. A patient with subchondral sclerosis may show minimal or no symptoms while more serious osteoarthritis may call for more invasive treatment.

The goals of OA treatment are to minimize pain and maximize function, and can be accomplished by:

When the above treatments fail, surgery may become an option. Joint replacement surgery or an osteotomy may be recommended to remove deteriorated cartilage and bone and replace it with a prosthetic.


In addition to continued deterioration of cartilage and bone, subchondral sclerosis can create cracks in the bone that allows joint fluid to leak into the underlying bone, called subchondral bone cysts (SBCs), which can be a sign of advanced arthritic changes.


Osteoarthritis cannot be prevented, but the progression of cartilage damage can be slowed by:

  • Avoiding high-impact activities, such as jumping and long-distance running
  • Strengthening and stretching muscles
  • Increasing range of motion through exercises
  • Using braces and orthotics to reduce load and add stability
  • Weight loss

Book Your Appointment Today

At OrthoNeuro, our orthopedic surgeons are helping many patients living with arthritis. Book your appointment today to see how they can help relieve your symptoms and get you moving again. We have many locations throughout Columbus, Ohio. Contact us today!


Medically Reviewed by Nick Cheney, DO

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