Osteomyelitis physical examination: Difference between revisions
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==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 | 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 | *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 === | === Appearance of the Patient === | ||
Patients with osteomyelitis usually appear ill | Patients with osteomyelitis usually in pain, and they appear ill. | ||
===Vital Signs=== | ===Vital Signs=== | ||
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*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]] | ||
*Unstable joint in patients with | *Unstable joint in patients with infection of their prosthesis. | ||
===Common Locations=== | ===Common Locations=== | ||
=====Hematogenous Osteomyelitis===== | =====Hematogenous Osteomyelitis===== | ||
*[[Long bone]] [[metaphysis]] (typically [[tibia]] and [[femur]]) in children<ref name="LewWaldvogel2004"></ref> | *[[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 | :*Vertebral osteomyelitis involves adjacent [[vertebrae]] and [[intervertebral disc]] | ||
=====Contiguous-focus Osteomyleitis===== | =====Contiguous-focus Osteomyleitis===== | ||
*[[Hip]], [[knee]], [[elbow]] due to prosthesis | *[[Hip]], [[knee]], [[elbow]], due to infection of prosthesis | ||
*[[Long bones]] due to [[fracture]] | *[[Long bones]] due to [[fracture]] | ||
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[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
[[Category:Emergency mdicine]] | |||
[[Category:Disease]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] | [[Category:Infectious disease]] | ||
Latest revision as of 23:28, 29 July 2020
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Osteomyelitis Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Osteomyelitis physical examination On the Web |
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American Roentgen Ray Society Images of Osteomyelitis physical examination |
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Risk calculators and risk factors for Osteomyelitis physical examination |
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
- Swelling[1]
- Redness
- Tenderness (except in diabetic patients with advanced neuropathy)
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
- Long bone metaphysis (typically tibia and femur) in children[2]
- 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
- Vertebral osteomyelitis involves adjacent vertebrae and intervertebral disc
Contiguous-focus Osteomyleitis
- Hip, knee, elbow, due to infection of prosthesis
- Long bones due to fracture
Osteomyelitis Secondary to Vascular Insufficiency
- Toes, metatarsal heads, and tarsal bones
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
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![Osteomyelitis. With permission from Dermatology Atlas.[5]](/images/3/3a/Osteomyelitis01.jpg)
Osteomyelitis. With permission from Dermatology Atlas.[5]
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![Osteomyelitis. With permission from Dermatology Atlas.[5]](/images/d/d0/Osteomyelitis02.jpg)
Osteomyelitis. With permission from Dermatology Atlas.[5]
-
![Osteomyelitis. With permission from Dermatology Atlas.[5]](/images/7/7a/Osteomyelitis03.jpg)
Osteomyelitis. With permission from Dermatology Atlas.[5]
![Osteomyelitis. With permission from Dermatology Atlas.[5]](/index.php/File:Osteomyelitis01.jpg)
![Osteomyelitis. With permission from Dermatology Atlas.[5]](/index.php/File:Osteomyelitis02.jpg)
![Osteomyelitis. With permission from Dermatology Atlas.[5]](/index.php/File:Osteomyelitis03.jpg)
References
- ↑ Lew, Daniel P.; Waldvogel, Francis A. (1997). "Osteomyelitis". New England Journal of Medicine. 336 (14): 999–1007. doi:10.1056/NEJM199704033361406. ISSN 0028-4793.
- ↑ 2.0 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.
- ↑ 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.
- ↑ Kliegman, Robert (2016). Nelson textbook of pediatrics. Phialdelphia, PA: Elsevier. ISBN 978-1455775668.
- ↑ 5.0 5.1 5.2 "Dermatology Atlas".