Osteomyelitis physical examination: Difference between revisions
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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> | 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> | ||
*Draining [[sinus]] tract | *Draining [[sinus]] tract | ||
*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 [[prosthesis]] infection | *Unstable joint in patients with [[prosthesis]] infection | ||
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=====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 likelihood of infection spreading to [[epiphysis]] and joint cavity | ||
*[[Lumbar vertebrae]] in elderly patients | *[[Lumbar vertebrae]] in elderly patients | ||
:*Vertebral osteomytelitis involves adjacent [[vertebrae]] and [[intervertebral disc]] | :*Vertebral osteomytelitis involves adjacent [[vertebrae]] and [[intervertebral disc]] | ||
=====Contiguous-focus Osteomyleitis===== | =====Contiguous-focus Osteomyleitis===== | ||
*Hip, knee, elbow due to prosthesis infection | *[[Hip]], [[knee]], [[elbow]] due to prosthesis infection | ||
*Long bones due to fracture | *[[Long bones]] due to [[fracture]] | ||
=====Osteomyelitis Secondary to Vascular Insufficiency===== | =====Osteomyelitis Secondary to Vascular Insufficiency===== | ||
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!Prevalence | !Prevalence | ||
|- | |- | ||
|Femur | |[[Femur]] | ||
|23-28% | |23-28% | ||
|- | |- | ||
|Tibia | |[[Tibia]] | ||
|20-26% | |20-26% | ||
|- | |- | ||
|Humerus | |[[Humerus]] | ||
|8-13% | |8-13% | ||
|- | |- | ||
|Radius | |[[Radius]] | ||
|5-6% | |5-6% | ||
|- | |- | ||
|Phalanx | |[[Phalanx]] | ||
|2-4% | |2-4% | ||
|- | |- | ||
|Pelvis | |[[Pelvis]] | ||
|5-9% | |5-9% | ||
|- | |- | ||
|Calcaneus | |[[Calcaneus]] | ||
|4-6% | |4-6% | ||
|- | |- | ||
|Ulna | |[[Ulna]] | ||
|5-6% | |5-6% | ||
|- | |- | ||
|Metatarsal | |[[Metatarsal]] | ||
|~2% | |~2% | ||
|- | |- | ||
|Vertebrae | |[[Vertebrae]] | ||
|2-4% | |2-4% | ||
|- | |- | ||
|Sacrum | |[[Sacrum]] | ||
|~2% | |~2% | ||
|- | |- | ||
|Clavicle | |[[Clavicle]] | ||
|1-2% | |1-2% | ||
|- | |- | ||
|Skull | |[[Skull]] | ||
|~1% | |~1% | ||
|} | |} | ||
Revision as of 14:48, 31 March 2017
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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 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
- 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 appear ill and painful.
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 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
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".