Osteomyelitis physical examination: Difference between revisions
No edit summary |
|||
| Line 11: | Line 11: | ||
===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]]) | ||
*Decreased sensation | |||
*Poor [[capillary refill]] | |||
===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 | *Sequestra | ||
*Draining [[sinus]] tract | *Draining [[sinus]] tract | ||
| Line 27: | Line 29: | ||
===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 likelihood of infection spreading to [[epiphysis]] and joint cavity. | ||
*[[Lumbar vertebrae]] in elderly patients | *[[Lumbar vertebrae]] in elderly patients | ||
Revision as of 20:35, 18 April 2016
|
Osteomyelitis Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Osteomyelitis physical examination On the Web |
|
American Roentgen Ray Society Images of Osteomyelitis physical examination |
|
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.
Overview
Patients with acute osteomyelitis may present with fever, local swelling, 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.
Physical Examination
Vital Signs
Acute Osteomyelitis
- Swelling[1]
- Redness
- Tenderness (except in diabetic patients with advanced neuropathy)
- Decreased sensation
- Poor capillary refill
Chronic Osteomyelitis
Patients with chronic osteomyelitis may present with acute signs in addition to the following:[2]
- Sequestra
- Draining sinus tract
- Thickened periosteum
- Unhealing ulcers, particularly those over bony prominences or any ulcer in which bone is palpable by blunt probe[3]
- Unhealing fractures
- Brodie's abscess
- Unstable joint in patients with prosthesis infection
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 likelihood of infection spreading to epiphysis and joint cavity.
- Lumbar vertebrae in elderly patients
- Vertebral osteomytelitis involves adjacent vertebrae and intervertebral disc
Contiguous-focus Osteomyleitis
- Hip, knee, elbow due to prosthesis infection
- Long bones due to fracture
Osteomyelitis Secondary to Vascular Insufficiency
- Toes, metatarsal heads, and tarsal bones
Gallery
-
![Osteomyelitis. With permission from Dermatology Atlas.[4]](/images/3/3a/Osteomyelitis01.jpg)
Osteomyelitis. With permission from Dermatology Atlas.[4]
-
![Osteomyelitis. With permission from Dermatology Atlas.[4]](/images/d/d0/Osteomyelitis02.jpg)
Osteomyelitis. With permission from Dermatology Atlas.[4]
-
![Osteomyelitis. With permission from Dermatology Atlas.[4]](/images/7/7a/Osteomyelitis03.jpg)
Osteomyelitis. With permission from Dermatology Atlas.[4]
![Osteomyelitis. With permission from Dermatology Atlas.[4]](/index.php/File:Osteomyelitis01.jpg)
![Osteomyelitis. With permission from Dermatology Atlas.[4]](/index.php/File:Osteomyelitis02.jpg)
![Osteomyelitis. With permission from Dermatology Atlas.[4]](/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.
- ↑ 4.0 4.1 4.2 "Dermatology Atlas".