Osteomyelitis physical examination

Osteomyelitis Microchapters
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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.

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
• Pathological fractures
• Brodie's abscess
• Unstable joint in patients with prothesis 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.