Osteomyelitis physical examination
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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
- 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]
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![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".