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.

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

• Fever

Acute Osteomyelitis

• Swelling
• 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:

• Sequestra
• Draining sinus tract
• Thickened periosteum
• Unhealing ulcers, particularly those over bony prominences or any ulcer in which bone is palpable by blunt probe
• 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

• 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

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  Osteomyelitis. With permission from Dermatology Atlas.

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  Osteomyelitis. With permission from Dermatology Atlas.

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  Osteomyelitis. With permission from Dermatology Atlas.