Osteomyelitis physical examination: Difference between revisions

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__NOTOC__
__NOTOC__
{{Osteomyelitis}}
{{Osteomyelitis}}
{{CMG}}; {{AE}} {{KS}}; {{NRM}}
{{CMG}}; {{AE}} {{KS}}; {{NRM}},{{MehdiP}}


==Overview==
==Overview==
Patients with acute osteomyelitis may present with [[fever]], local [[swelling]], [[Redness of the skin|redness]], and [[tenderness]]. Patients with with chronic osteomyelitis may present with the following additional signs: bone sequestra, draining [[sinus]] tracts, thickened [[periosteum]], unhealing [[ulcers]], unhealing [[fractures]], [[Brodie's abscess]], and unstable joints in cases of infected prosthesis. Common affected bones include [[long bones]] and [[lumbar vertebrae]] in hematogenous osteomyelitis, hips, knees and elbows in contiguous-focus osteomyelitis, and foot bones in osteomyelitis secondary to vascular insufficiency.
Patients with acute osteomyelitis may present with [[fever]], local [[swelling]], [[Redness of the skin|redness]], and [[tenderness]]. Patients with with chronic osteomyelitis may present with additional signs such as draining [[sinus]] tracts, unhealing [[ulcers]], unhealing [[fractures]], [[Brodie's abscess]], and unstable joints in cases of infected prosthesis. Commonly affected bones include [[long bones]] and [[lumbar vertebrae]] in hematogenous osteomyelitis, hips, knees and elbows in contiguous-focus osteomyelitis, and bones of the feet in osteomyelitis secondary to vascular insufficiency.


==Physical Examination==
==Physical Examination==
*Neonates might exhibit pseudoparalysis or pain with movement of the affected extremity (e.g., diaper changes). In children and adults, it depends on the site of involvement
=== Appearance of the Patient ===
Patients with osteomyelitis usually in pain, and they appear ill.
===Vital Signs===
===Vital Signs===
*[[Fever]]
*[[Fever]]
===Acute Osteomyelitis===
===Acute Osteomyelitis===
*[[Swelling]]
*[[Swelling]]<ref name="LewWaldvogel1997">{{cite journal|last1=Lew|first1=Daniel P.|last2=Waldvogel|first2=Francis A.|title=Osteomyelitis|journal=New England Journal of Medicine|volume=336|issue=14|year=1997|pages=999–1007|issn=0028-4793|doi=10.1056/NEJM199704033361406}}</ref>
*[[Redness of the skin|Redness]]
*[[Redness of the skin|Redness]]
*[[Tenderness]] (except in diabetic patients with advanced [[neuropathy]])
*[[Tenderness]] (except in diabetic patients with advanced [[neuropathy]])


===Chronic Osteomyelitis===
===Chronic Osteomyelitis===
Patients with chronic osteomyelitis may present with acute signs in addition to the following:
Patients with chronic osteomyelitis may present with acute signs in addition to the following:<ref name="LewWaldvogel2004">{{cite journal|last1=Lew|first1=Daniel P|last2=Waldvogel|first2=Francis A|title=Osteomyelitis|journal=The Lancet|volume=364|issue=9431|year=2004|pages=369–379|issn=01406736|doi=10.1016/S0140-6736(04)16727-5}}</ref>
*Sequestra
*Draining [[sinus]] tract
*Draining [[sinus]] tract
*Thickened [[periosteum]]
*Unhealing [[ulcers]], particularly those over bony prominences or any ulcer in which bone is palpable by blunt [[probe]]<ref name="LipskyBerendt2004">{{cite journal|last1=Lipsky|first1=Benjamin A.|last2=Berendt|first2=Anthony R.|last3=Deery|first3=H. Gunner|last4=Embil|first4=John M.|last5=Joseph|first5=Warren S.|last6=Karchmer|first6=Adolf W.|last7=LeFrock|first7=Jack L.|last8=Lew|first8=Daniel P.|last9=Mader|first9=Jon T.|last10=Norden|first10=Carl|last11=Tan|first11=James S.|title=Diagnosis and Treatment of Diabetic Foot Infections|journal=Clinical Infectious Diseases|volume=39|issue=7|year=2004|pages=885–910|issn=1058-4838|doi=10.1086/424846}}</ref>
*Unhealing [[ulcers]], particularly those over bony prominences or any ulcer in which bone is palpable by blunt probe<ref name="LipskyBerendt2004">{{cite journal|last1=Lipsky|first1=Benjamin A.|last2=Berendt|first2=Anthony R.|last3=Deery|first3=H. Gunner|last4=Embil|first4=John M.|last5=Joseph|first5=Warren S.|last6=Karchmer|first6=Adolf W.|last7=LeFrock|first7=Jack L.|last8=Lew|first8=Daniel P.|last9=Mader|first9=Jon T.|last10=Norden|first10=Carl|last11=Tan|first11=James S.|title=Diagnosis and Treatment of Diabetic Foot Infections|journal=Clinical Infectious Diseases|volume=39|issue=7|year=2004|pages=885–910|issn=1058-4838|doi=10.1086/424846}}</ref>
*Unhealing [[fractures]]
*Unhealing [[fractures]]
*[[Brodie's abscess]]
*Unstable joint in patients with infection of their prosthesis.
*Unstable joint in patients with [[prosthesis]] infection


===Common Locations===
===Common Locations===
=====Hematogenous Osteomyelitis=====
=====Hematogenous Osteomyelitis=====
*[[Long bone]] [[metaphysis]] (typically [[tibia]] and [[femur]]) in children
*[[Long bone]] [[metaphysis]] (typically [[tibia]] and [[femur]]) in children<ref name="LewWaldvogel2004"></ref>
:*Presence of transphyseal blood vessels and an immature growth plate in infants increase likelihood of infection spreading to [[epiphysis]] and joint cavity.
:*Presence of transphyseal [[blood vessels]] and an immature [[growth plate]] in infants increase the likelihood of the infection spreading to the [[epiphysis]] and joint cavity.
*[[Lumbar vertebrae]] in elderly patients
*[[Lumbar vertebrae]] in elderly patients
:*Vertebral osteomytelitis involves adjacent [[vertebrae]] and [[intervertebral disc]]
:*Vertebral osteomyelitis involves adjacent [[vertebrae]] and [[intervertebral disc]]


=====Contiguous-focus Osteomyleitis=====
=====Contiguous-focus Osteomyleitis=====
*Hip, knee, elbow due to prosthesis infection
*[[Hip]], [[knee]], [[elbow]], due to infection of prosthesis
*Long bones due to fracture
*[[Long bones]] due to [[fracture]]


=====Osteomyelitis Secondary to Vascular Insufficiency=====
=====Osteomyelitis Secondary to Vascular Insufficiency=====
* [[Toes]], [[metatarsal]] heads, and [[tarsal]] bones
* [[Toes]], [[metatarsal]] heads, and [[tarsal]] bones
=== Common sites of ostemyelitis in children include:<ref>{{cite book | last = Kliegman | first = Robert | title = Nelson textbook of pediatrics | publisher = Elsevier | location = Phialdelphia, PA | year = 2016 | isbn = 978-1455775668 }}</ref> ===
{| class="wikitable"
!Sites of osteomyelitis in children
!Prevalence
|-
|[[Femur]] 
|23-28%
|-
|[[Tibia]] 
|20-26%
|-
|[[Humerus]]
|8-13%
|-
|[[Radius]]
|5-6%
|-
|[[Phalanx]]
|2-4%
|-
|[[Pelvis]]
|5-9%
|-
|[[Calcaneus]]
|4-6%
|-
|[[Ulna]]
|5-6%
|-
|[[Metatarsal]]
|~2%
|-
|[[Vertebrae]]
|2-4%
|-
|[[Sacrum]]
|~2%
|-
|[[Clavicle]]
|1-2%
|-
|[[Skull]]
|~1%
|}


==Gallery==
==Gallery==
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==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Orthopedics]]
[[Category:Orthopedics]]
[[Category:Bacterial diseases]]
[[Category:Emergency mdicine]]
[[Category:Skeletal disorders]]
[[Category:Disease]]
[[Category:Up-To-Date]]
[[Category:Infectious disease]]
[[Category:Infectious disease]]
[[Category:Disease]]
{{WH}}
{{WS}}

Latest revision as of 23:28, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]; Nate Michalak, B.A.,Seyedmahdi Pahlavani, M.D. [3]

Overview

Patients with acute osteomyelitis may present with fever, local swelling, redness, and tenderness. Patients with with chronic osteomyelitis may present with additional signs such as draining sinus tracts, unhealing ulcers, unhealing fractures, Brodie's abscess, and unstable joints in cases of infected prosthesis. Commonly affected bones include long bones and lumbar vertebrae in hematogenous osteomyelitis, hips, knees and elbows in contiguous-focus osteomyelitis, and bones of the feet in osteomyelitis secondary to vascular insufficiency.

Physical Examination

  • Neonates might exhibit pseudoparalysis or pain with movement of the affected extremity (e.g., diaper changes). In children and adults, it depends on the site of involvement

Appearance of the Patient

Patients with osteomyelitis usually in pain, and they appear ill.

Vital Signs

Acute Osteomyelitis

Chronic Osteomyelitis

Patients with chronic osteomyelitis may present with acute signs in addition to the following:[2]

  • Draining sinus tract
  • Unhealing ulcers, particularly those over bony prominences or any ulcer in which bone is palpable by blunt probe[3]
  • Unhealing fractures
  • Unstable joint in patients with infection of their prosthesis.

Common Locations

Hematogenous Osteomyelitis
Contiguous-focus Osteomyleitis
Osteomyelitis Secondary to Vascular Insufficiency

Common sites of ostemyelitis in children include:[4]

Sites of osteomyelitis in children Prevalence
Femur 23-28%
Tibia 20-26%
Humerus 8-13%
Radius 5-6%
Phalanx 2-4%
Pelvis 5-9%
Calcaneus 4-6%
Ulna 5-6%
Metatarsal ~2%
Vertebrae 2-4%
Sacrum ~2%
Clavicle 1-2%
Skull ~1%

Gallery

References

  1. ↑ Lew, Daniel P.; Waldvogel, Francis A. (1997). "Osteomyelitis". New England Journal of Medicine. 336 (14): 999–1007. doi:10.1056/NEJM199704033361406. ISSN 0028-4793.
  2. ↑ 2.0 2.1 Lew, Daniel P; Waldvogel, Francis A (2004). "Osteomyelitis". The Lancet. 364 (9431): 369–379. doi:10.1016/S0140-6736(04)16727-5. ISSN 0140-6736.
  3. ↑ Lipsky, Benjamin A.; Berendt, Anthony R.; Deery, H. Gunner; Embil, John M.; Joseph, Warren S.; Karchmer, Adolf W.; LeFrock, Jack L.; Lew, Daniel P.; Mader, Jon T.; Norden, Carl; Tan, James S. (2004). "Diagnosis and Treatment of Diabetic Foot Infections". Clinical Infectious Diseases. 39 (7): 885–910. doi:10.1086/424846. ISSN 1058-4838.
  4. ↑ Kliegman, Robert (2016). Nelson textbook of pediatrics. Phialdelphia, PA: Elsevier. ISBN 978-1455775668.
  5. ↑ 5.0 5.1 5.2 "Dermatology Atlas".
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