Osteomyelitis physical examination

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.

• 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

Patients with osteomyelitis usually in pain, and they appear ill.

• Fever

• Swelling^[1]
• Redness
• Tenderness (except in diabetic patients with advanced neuropathy)

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.

• 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

• Hip, knee, elbow, due to infection of prosthesis
• Long bones due to fracture

• Toes, metatarsal heads, and tarsal bones

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