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 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

Vital Signs

Fever

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]

Sequestra
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

Osteomyelitis. With permission from Dermatology Atlas.^[5]
Osteomyelitis. With permission from Dermatology Atlas.^[5]
Osteomyelitis. With permission from Dermatology Atlas.^[5]

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".

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[LewWaldvogel1997-1] Lew, Daniel P.; Waldvogel, Francis A. (1997). "Osteomyelitis". New England Journal of Medicine. 336 (14): 999–1007. doi:10.1056/NEJM199704033361406. ISSN 0028-4793.

[LewWaldvogel2004-2] 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.

[LipskyBerendt2004-3] 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.

[Dermatology_Atlas-5] 5.0 ^5.1 ^5.2 "Dermatology Atlas".

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