What is periostitis? Treatment and basic information about this disease will be presented below. You will also learn about the reasons why this disease develops, how it manifests itself and is diagnosed.
Basic information
What is periostitis (diagnosis, treatment of this pathology will be discussed later)? In modern medicine, this term is used to refer to the inflammatory process that occurs in the periosteum of the bone.
As you know, the periosteum is a connective tissue in the form of a film, which is located along the entire outer surface of the bone. Usually inflammatory process begins in the inner or outer layers of the periosteum, after which it penetrates into its thickness.
Reasons for development
Why does periostitis develop? Treatment of this disease should begin only after the cause of its occurrence has been identified. These include the following:
- Various injuries, including dislocations, bruises, bone fractures, sprains and ruptures of tendons, wounds.
- Inflammation of nearby tissues, which provoked infection of the periosteum.
- Specific causes - inflammation of the periosteum occurs due to diseases such as tuberculosis, actinomycosis, syphilis, and so on.
- Toxic causes are the effects of toxins on periosteal tissues.
- Allergic or rheumatic causes - inflammation occurs due to the reaction of periosteal tissues to allergens that have penetrated into it.
Signs of the disease
How is periostitis manifested, the treatment of which is described below? The symptoms of this disease depend on its type. Such a disease may be accompanied by swelling at the site of inflammation with severe pain, increased local temperature, impaired support function, mobility of the skin over the lesion, increased pulse and breathing of the patient, loss of appetite, weakness, fatigue and general depression.
What bones are affected?
Periostitis of the jaw, a photo of which you can find in this article, is an inflammatory process that occurs in the alveolar region mandible or process of the upper.
Most often, this disease develops due to diseased teeth, including undiagnosed or untreated pulpitis or periodontitis. Also, inflammation can be caused by infection in the periosteum from other organs along with the flow of lymph or blood.
If the treatment of such a disease is not carried out on time, then periostitis will provoke development. As a result, it can go beyond the periosteum and get into the surrounding tissues, which will cause an abscess or phlegmon.
So how to cure periostitis of the jaw? The treatment of this disease is carried out in exactly the same way as the therapy of other inflammations. It should be recalled that periostitis can also affect organs such as:
Disease classification
How is periostitis classified? The treatment of this disease depends on its type and stage of development. In modern medicine, there are several types of the disease in question. They depend on the causes of their occurrence and the nature
- Exudative periostitis, including serous, serous-fibrinous, fibrinous and purulent types.
- Proliferative periostitis, which includes ossifying and fibrous types.
It should be noted that exudative periostitis proceed quickly and acutely, and proliferative - are of a chronic nature.
Also, the disease in question can be:
- simple;
- tuberculosis;
- syphilitic;
- gummous and so on.
According to the duration of the course, 2 are distinguished different forms this disease:
- acute periostitis (treatment should be prescribed on time so that the process does not go into a chronic stage);
- chronic (difficult to treat).
According to the involvement in the resulting inflammation of microorganisms, the following types of periostitis are distinguished:
Diagnostics
Treatment of purulent periostitis should begin only after its diagnosis. Its methods differ depending on the form of the course and the type of disease.
In acute illness, questioning and examination of the patient are effective. Also important are the results general analysis blood. As for the X-ray examination, in this case it is ineffective.
With the development of nasal periostitis, rhinoscopy is often used.
Chronic periostitis is diagnosed by X-ray. With the help of the image taken, it is possible to identify not only the localization of the lesion, but also its boundaries, shape, size and nature of the layers. Also, this method helps to identify necrotic changes. bone tissue and the degree of penetration of the inflammatory process into it.
Differential Diagnosis
This procedure is used only if an accurate diagnosis is required, since the patient has symptoms of several similar diseases.
With purulent and acute periostitis, it should be distinguished from acute osteomyelitis, periodontitis, phlegmon and abscesses caused by other causes, as well as from purulent diseases of the lymph nodes, salivary glands and others.
With specific, aseptic and chronic periostitis, an x-ray examination is mandatory. It helps to identify growths and thickenings on the bone, as well as bone neoplasms and necrotic changes.
It should also be noted that the differential diagnosis of a chronic disease should be carried out in conjunction with the detection of malignant tumors and osteomyelitis.
In the event that during the X-ray examination there were serious difficulties with the diagnosis, then in this case, specialists resort to a biopsy.
Periostitis: treatment
This disease is not always treated with antibiotics.
With a traumatic form of the disease in the initial stage of development, complete rest is an effective measure. Various ice compresses and physiotherapy are also used, including UHF, ozocerite applications, electrophoresis, ultraviolet radiation. With this form of periostitis, antibiotics are prescribed only if infection of the lesion is suspected.
Therapy of aseptic periostitis is carried out with the use of physiotherapy. To do this, use applications of permanent magnets, which reduce the amount of exudate. At the second stage of treatment, STP or laser therapy is used to restore the structure of the periosteum and resolve its thickenings.
With purulent periostitis is shown surgical intervention, during which the periosteum is dissected, and the existing pus is taken out.
As for the acute form of periostitis, it requires not only an operation, but also the appointment of antibiotics, as well as restorative medicines, physiotherapy and medicines eliminating intoxication of the body.
With the development of chronic periostitis, the patient is prescribed a course of general strengthening drugs and antibiotics. Also, in the treatment of this form of the disease, physiotherapy is indicated (laser therapy, paraffin therapy, iontophoresis with 5% promoting resorption and pathological thickening.
Disease prevention
Is it possible to get rid of such a disease as periostitis on your own? Home treatment of this disease is undesirable. This is due to the fact that folk methods with such a pathology, they are ineffective, and a neglected disease can pose a serious threat to the patient's life.
Prevention is the timely elimination of the causes that lead to the onset of the disease. For example, periostitis of the jaw or tooth can be prevented by timely treatment of pulpitis, caries and periodontitis.
Aseptic periostitis caused by tuberculosis, osteomyelitis or syphilis can be prevented by therapy of the underlying disease.
Traumatic and post-traumatic types of this disease are prevented through the immediate treatment of periosteal tissue damage with medical and physiotherapeutic procedures.
Disease prognosis
The prognosis of periostitis depends on its form and type, as well as timely treatment.
Most often, patients manage to get rid of acute and traumatic types of the disease.
With purulent periostitis, especially in advanced cases and with untimely treatment, the prognosis is unfavorable. In this case, complications such as inflammation of all bone tissues and the occurrence of sepsis may occur.
Periostitis of the bone is a disease that is characterized by an inflammatory process in one of the layers of the bone, or in all layers (in cases of neglect of the disease).
Periostitis, which literally translates into Russian as “periosteum”, is a disease that is characterized by inflammation of one of the layers of the periosteum (lower or upper), which eventually passes to all other layers. Since the periosteum and bone are in close proximity to each other, inflammation can quickly move from one to the other. In case of detection of a disease in the late stages or complicated by improper therapeutic treatment, excessive loads, surgical treatment may be necessary.
ICD-10 code
M90.1* Periostitis in other infectious diseases classified elsewhere
Causes of periostitis of the bone
Periostitis of the bone can develop in different parts body. This disease often manifests itself as a result of injuries, bruises, serious cuts, fractures. In addition, the causes of bone periostitis are interactions with other foci of inflammation (muscles or bones).
The cause of the disease can also be allergic or inflammatory processes in other tissues, which as a result are transmitted to the periosteum, continuing to progress. Less common is periostitis of the bone, which has arisen as a result of a general disease of the body or any specific ailments that lead to the formation of toxins in the body.
Symptoms of periostitis of the bone
The main symptoms of periostitis of the bone are a feeling of pain during various movements, discomfort and slight swelling in the areas of inflammation. The color of the skin in the affected areas does not change, there are no spots, redness or a bluish tint. If periostitis of the bone resulted from a bruise or fracture, then after 2-3 weeks all the symptoms and the inflammation itself disappear. In case of exacerbation and fibrous growth of bone tissue, the disease becomes chronic. This stage, among other things, is characterized by reddening of the skin. If periostitis of the bone is not treated therapeutically at this stage, a serious complication may occur in the future, leading to bone damage and purulent periostitis.
Periostitis of the tibia
This type of disease occurs as a result of serious and prolonged physical exertion without prior preparation. The main symptom of this type of periostitis is pain in the back of the lower leg, which manifests itself some time after exercise. Very often, periostitis of the tibia occurs in soldiers of the first year of service or in athletes after a break in classes or especially difficult exercises that are unusual for the body. An external sign of the disease is a slight swelling of the lesion. On the skin, no changes are observed. When feeling the lower leg, there are also painful, unpleasant sensations. Periostitis of the bone in the first 20 days cannot be determined on x-ray, only after this period, with the help of an x-ray and a doctor's examination, the diagnosis can be accurately made.
If the patient has a suspicion of periostitis of the tibia, he should immediately stop physical exercise thereby reducing the risk of developing and complication of the disease.
Periostitis of the tibia
Periostitis of the bone most often occurs in areas where the bone is poorly protected by soft tissues. The causes of the disease are bruises, fractures. The ulna and tibia are especially vulnerable. Most often, in these places, the inflammatory process goes away by itself within a few weeks.
Extremely rarely, periostitis of the tibia can cause complications, the formation of new bone tissue and the need for therapeutic, or even surgical (in especially severe cases) intervention.
Periostitis of the tibia
Periostitis of the fibula can be both an independent focal disease and the first phase of periostitis, which develops into a disease of the tibia. Often, periostitis of the tibia often occurs as a result of a long-term varicose process. Like any other type of periostitis, the disease of the fibula is accompanied by painful sensations during loads on the lower leg, palpation of the injury site and the inflammatory process. On the skin at the first stage, no signs appear.
Periostitis of the humerus
Periostitis of the humerus is often characterized by the formation of pus in the affected area, as in other tubular bones, such as the thigh, less often the tibia. This disease occurs as a result of infection from the outside, or by infection with an infection from other organs.
In mild forms of periostitis of the humerus, the affected areas, as in other cases, are swollen, with palpation or stress, pain and discomfort appear. Such mild forms of periostitis can fade on their own after a few weeks, provided there are no stresses and irritating factors. There are no manifestations on the skin.
Periostitis of the humerus can occur as a result of excessive loads or serious injuries.
Periostitis of the bones of the nose
Periostitis of the bones of the nose is a disease of the bones of the nose, which is characterized by inflammation, pain and slight swelling in the early stages. The causes of the disease are various injuries of the nose, a fracture, infectious infections from other organs. With periostitis of the nasal bones, deformation of the nose is observed, touching or feeling is accompanied by severe pain. Periostitis of the bone must be diagnosed, investigated and treated, taking into account all previous, even the smallest injuries and diseases of the whole organism.
Periostitis of the calcaneus
Periostitis of the calcaneus occurs for the same reasons as in other parts of the human body - as a result of injuries, bruises, infection. This disease of the heel bone can result in the formation of a heel spur.
Periostitis of the bone is very difficult to diagnose correctly in the early stages of the disease, but if there is a suspicion of this particular disease, then any strong physical exertion on the focus of the disease should be stopped. On the skin, manifestations are often not observed. Signs of the disease are pain in the affected areas, discomfort and slight swelling.
Diagnosis of periostitis of the bone
X-rays fix the disease only in the later stages, when any deformation of the bone is already occurring. In the initial stages, only external signs appear - swelling, redness of the skin.
At the first manifestations of an anomaly (pain, swelling, discomfort), any physical activity on the intended affected area should be significantly reduced. Diagnosis of bone periostitis includes accounting for previous injuries, diseases of the whole organism, infectious diseases other organs adjacent to the site of the lesion.
Treatment of periostitis of the bone
Treatment of periostitis of the bone in the first stages may include only the maximum reduction in the load on the affected area, which will last from 2 to 3 weeks, until the inflammation completely subsides and recovery. In this case, the entire healing process can take place at home. Pain should be quenched with cold and painkillers, and in addition, antibiotic therapy should be carried out.
For more effective recovery, drugs such as sulfadimisin or sulfadimethoxine, biseptol, analgin or antihistamines, such as diphenhydramine, diazolin, suprastin, are prescribed.
In addition, with conservative treatment, anti-inflammatory drugs such as lornoxicam are used, which accelerate the decay of
inflammation and accelerate the process of full recovery. The dose of each drug must be selected individually, according to the instructions or prescriptions of the doctor.
For the general condition of the bones, it is desirable to use preparations containing calcium, for example, a 10% solution of calcium chloride, calcium gluconate, calcium lactate and, of course, vitamins, especially vitamin C.
Under the conditions of home treatment, it is necessary to use means that will help to fight infections as effectively as possible. These can be - warming vaseline dressings for 10-12 hours and dry heat, such as Sollux, Minin's lamp or blue light.
For pain relief folk remedies you can use lard (apply pieces of bacon to the places of swelling) or decoctions of lemon balm (which also treat the affected areas, relieving pain and swelling). The main task is to eliminate irritation and infection.
To speed up recovery and consolidate the effect, it is necessary to carry out physiotherapeutic procedures - UHF and paraffin, massage and therapeutic (light) physical education.
In the case of purulent periostitis of the bone, only surgical intervention is used. The doctor makes an incision in the affected area, disinfects the area around this place, and a drain is inserted through which the pus comes out. Recovery after surgery, on average, is longer than a full-fledged conservative treatment.
If we are talking about periostitis of the tooth, then such a tooth is often removed, and for 4-6 regular rinses with a warm solution of potassium permanganate or 1-2% sodium bicarbonate solution are recommended.
Treatment of periostitis of the tibia
Treatment of periostitis of the tibia with physical exercises is permissible only if they help strengthen the muscles in general, and not overstrain them. Doing physical exercises through pain should not be, it can only harm. If the symptoms do not go away for more than 3 weeks, an x-ray should be taken immediately, after which serious therapeutic or even surgical treatment may be necessary.
Since periostitis of the tibia often occurs as a result of overload, then the best prevention here - it is always sensible to assess your capabilities in certain power, exercise. Treatment of the periosteum always proceeds slowly, therefore, significant loads should be patiently avoided for quite a long time.
Prognosis of periostitis of the bone
Periostitis is an inflammation of the periosteum, which originates in the outer layer of the bone, after which it penetrates inside. If timely treatment is not started, then osteoperiostitis may develop, when inflammation penetrates the bone tissue.
Characteristics of the disease
Periostitis is a sluggish or acute inflammatory process of the periosteum, which envelops the bones. According to ICD 10, the disease has the following codes:
- If there was a lesion of the pelvic or thigh area - M 90.15;
- With the localization of the inflammatory process in the lower leg - M 90.16;
- Periostitis of the calcaneus - M 90.17;
- With unspecified localization - M 90.19.
The foci of inflammation are located in the inner or outer layer, then they spread to the surrounding tissue. Treatment of periostitis of the periosteum is carried out by different specialists, based on the cause that caused the pathology. You may need help with this:
- Orthopedist;
- Phthisiatrician;
- Rheumatologist;
- Traumatologist;
- Oncologist;
- Venerologist.
The pathological focus can spread in different parts of the bone, depending on which the following types of disease are distinguished:
- Periostitis of the tibia;
- Periostitis of the fibula;
- Periostitis of the foot;
- Periostitis of the leg;
- Periostitis of the knee.
On a note!
The localization of the pathological process affects the symptoms of the disease and the choice of treatment tactics.
The shape of the flow is distinguished:
- Acute periostitis of the periosteum, which is characterized by the presence of a purulent process in the bone;
- Chronic periostitis is a kind of complication of an acute process.
Doctors distinguish the following classification:
- A simple view is often formed on the olecranon or tibia, formed as a result of trauma, prolonged inflammation in the periosteum;
- Purulent is formed in the tubular bone, occurs after the penetration of infection, bacteria, staphylococci, streptococci through a wound, hematoma;
- Fibrous develops against the background of prolonged irritation;
- Ossifying periostitis of the periosteum is caused by prolonged irritation with subsequent proliferation of bone tissue;
- Post-traumatic is provoked by injuries, characterized by the presence of a serous-mucous substance;
- Tuberculous develops against the background of tuberculosis, differs in the formation of purulent clots, fistulas. More often diagnosed in children;
- Syphilitic is formed against the background of venereal diseases;
- Serous is formed on the injured area, is characterized by painful swelling, elevated temperature body, which will eventually return to normal. At the initial stage, the swelling is characterized by a dense consistency, which later softens and becomes liquid;
- Linear, which on an X-ray image looks like a single line along the bone. It is observed against the background of a long-term sluggish inflammation of the periosteum, at the beginning of the formation of osteomelitis;
- Load periostitis occurs in places of increased load, foot, lower leg as a result of injury. It is characterized by pain, seals.
The reasons
Medicine identifies the following causes of periostitis:
- Injuries that may appear as bruises, dislocations, bone fractures, sprains, soft tissue injuries;
- Inflammation of a nearby tissue that occurs against the background of a pathological focus, which is located near the periosteum;
- Toxic. Some diseases provoke the formation of toxins in the body, their entry into the periosteum. Toxic substances are formed in a diseased organ, then they are carried throughout the body with the help of the circulatory or lymphatic system;
- Allergic. Thus, the periosteum reacts to allergens penetrating into it;
- Specific, in which the disease is formed against the background of tuberculosis, syphilis.
Symptoms
Usually, the symptoms of periostitis of the bone depend on its type and manifest themselves in the following reaction of the body:
- In the acute form of the disease, a slightly limited swelling occurs. When it is palpated, a feeling of pain is manifested, a local increase in temperature is determined. The symptom is lameness;
- With a fibrous form, a swelling is determined, which has a dense texture, not painful on palpation. There is no local increase in temperature, the mobility of the skin over the affected area is formed;
- With ossifying, a swelling appears with a sharp limitation, a hard consistency, an uneven surface. On palpation, pain is not determined, there is no local increase in temperature;
- Acute purulent periostitis is manifested by severe pain, deterioration of the general condition, fever, increased respiration, pulse, weakness, fatigue, depression. A painful swelling is determined, hot to the touch, with tension of the inflamed tissue.
Diagnosis
Diagnosis of periostitis of the periosteum varies from its form and type:
- In the acute form, the patient is examined and questioned. The most important aspect is the delivery of the CBC (general blood test), which will reveal the presence of inflammation. Fluoroscopy will be uninformative, since the disease is determined on an x-ray photo 2 weeks after formation;
- The chronic type is determined on an x-ray, which allows you to determine the exact localization of the process, the boundaries, shape, size, what character the layering has. The picture shows the degree of pathology lower extremities, as far as it has penetrated into the cortical layer, the presence of necrosis. Layers can be lacy, linear, needle-shaped, fringed, layered, comb-shaped.
Treatment
Treatment of the disease depends on its type and stage of the pathological process. In most cases, pathology can be dealt with with the help of conservative therapy.
Treatment of periostitis without the involvement of a purulent process
If periostitis of the periosteum occurs without the involvement of a purulent process, then therapy is carried out at home. The doctor prescribes antibacterial drugs, if necessary, painkillers. Cold compresses are applied to the inflamed joint.
After removing the symptoms, after 3-4 days, physiotherapy is prescribed, which improves blood circulation, relieves inflammation, swelling, and improves tissue regeneration. As physiotherapy for periostitis of the bone is used:
- electrophoresis;
- Magnet;
- Paraffin therapy;
- Ion therapy with 5% potassium iodide;
- Laser therapy promotes resorption of seals, restoration of the affected periosteum.
On a note!
Within a few days it is necessary to provide complete rest to the leg.
To achieve the desired result, the following are assigned:
- Sulfamide, Sulfadimetoksin, Sulfadimezin, Biseptol;
- Antihistamine, Suprastin, Diazolin;
- Anti-inflammatory drugs - Lornoxicam;
- Preparations that strengthen bone tissue - Calcium gluconate, Calcium chloride, Calcium lactate;
- For resorption of serous exudate in the affected area, local remedies are used, which are applied by application, Beloderm, Advantan;
- Non-steroidal drugs (Nurofen, Ibuprofen) contribute to the suppression of foci of inflammation, relieve pain;
- Restore the integrity of bone tissue wound healing agents Levomekol, Argosulfan;
- Treatment of periostitis of the lower leg is carried out by applying antiseptic, anesthetic ointments, Miromistin, Ketoprofen;
- Vitamin complexes.
Treatment of purulent periostitis
If the periosteum is damaged by purulent periostitis, then surgical intervention is required. The patient undergoes an opening of the abscess, drainage, followed by washing the cavity. This procedure produced using aseptic solutions, antibiotics. After the operation, daily replacement of drainage and sanitation is required for a week. For treatment is used:
- Antibiotic therapy with broad-spectrum drugs;
- antiallergic drugs;
- Vitamin complexes with zinc, fluorine, calcium, vitamin C.
After the removal of acute symptoms, the patient needs physiotherapy, which promotes tissue healing. If the process of suppuration is just beginning, then a compress with Dimexide, Vishnevsky ointment may be prescribed. chronic stage disease requires the appointment of antibiotics, restorative agents, absorbable physiotherapy.
Cold is applied to the affected area to reduce pain. It is forbidden to use a warm compress, as it provokes the spread of inflammation.
ethnoscience
Traditional medicine is allowed as an additional method to drug therapy for leg periostitis, physiotherapy. The following methods help to relieve pain, resorption of seals, hematomas:
- 100 gr. butter mix with livestock root. Apply as a compress to a sore spot;
- 100 gr. chop comfrey root, melt in a water bath 200 gr. butter. To mix everything. After cooling, apply the ointment to the affected area;
- Grate Adam's root to get 200 gr. raw materials, pour ½ l. alcohol. Insist 5 days. The resulting infusion rub the affected area.
Possible Complications
If you do not pay attention to the acute course of the disease, then serious complications can develop:
- Phlegmon, affecting the soft tissues located next to the diseased periosteum, characterized by purulent spillage, inflammation of the cell space and the absence of clear boundaries. This pathology of the bone has a rapid spread, occurs with fever, general malaise, lowering blood pressure, weakness, palpitations, inflammation of the lymph nodes located near the process;
- , causes necrosis of the bone marrow, bone, surrounding tissues. The patient has an increase in body temperature up to 40 degrees, a pronounced pain process occurs. If treatment starts late, then a fistula is formed;
- An abscess with clear boundaries and localization, accompanied by the formation of pus, a general deterioration in the condition, body aches, insomnia, the spread of pus into a nearby tissue;
- Sepsis, which is a severe condition caused by the penetration of the pathogen into the blood. This state characterized by a high risk of death as a result of the spread of infection throughout the body;
- Mediastinitis or acute periostitis is associated with infection in the mediastinum. Against the background of which there is shortness of breath, headache, chills, fever up to 40 degrees. If the patient is not provided with urgent assistance, then a fatal outcome is possible.
It is possible to cure periostitis at the initial stage, until the pathology has passed into the purulent stage. In this way, complications that are life-threatening for the patient can be avoided.
Periostitis(periostitis; anatomical periosteum periosteum + -itis) - inflammation of the periosteum. Usually begins in its inner or outer layer and then spreads to other layers. Due to the close connection between the periosteum (periosteum) and the bone, the inflammatory process easily passes from one tissue to another (osteoperiostitis).
According to the clinical course, periostitis is divided into acute (subacute) and chronic; according to the pathoanatomical picture, and partly according to etiology - into simple, fibrous, purulent, serous, ossifying, tuberculous, syphilitic.
Simple periostitis- acute aseptic inflammatory process, in which hyperemia, slight thickening and infiltration of the periosteum are observed. It develops after bruises, fractures (traumatic periostitis), as well as near inflammatory foci, localized, for example, in bones and muscles. Accompanied by pain and swelling in a limited area. Most often, the periosteum is affected in the area of \u200b\u200bbones that are poorly protected by soft tissues (for example, the anterior surface of the tibia).
The inflammatory process for the most part quickly subsides, but sometimes it can lead to the appearance of fibrous growths or the deposition of calcium salts and the formation of bone tissue (development of osteophytes), i.e. turns into ossifying periostitis.
Fibrous periostitis develops gradually and flows chronically. It arises under the influence of irritations lasting for years and is manifested by a callous fibrous thickening of the periosteum, tightly soldered to the bone. It is observed, for example, on the tibia in cases of chronic leg ulcers, bone necrosis, chronic inflammation of the joints, etc. Significant development fibrous tissue can lead to superficial bone destruction. In some cases, with a long duration of the process, a new formation of bone tissue is noted. After elimination of the stimulus, the reverse development of the process is usually observed.
Purulent periostitis usually develops as a result of infection when the periosteum is injured, penetration of infection into it from neighboring organs (for example, periostitis of the jaw with dental caries), as well as by the hematogenous route (for example, metastatic periostitis with pyemia).
With metastatic periostitis, the periosteum of a long tubular bone (most often the femur, tibia, humerus) or several bones at the same time is usually affected. Purulent periostitis is an obligatory component of acute purulent osteomyelitis. There are cases of purulent periostitis, in which it is not possible to detect the source of infection.
Purulent periostitis begins with hyperemia of the periosteum, the appearance of serous or fibrinous exudate in it. Then comes the purulent infiltration of the periosteum, and it is easily separated from the bone. The loose inner layer of the periosteum is saturated with pus, which then accumulates between the periosteum and the bone, forming a subperiosteal abscess. With a significant spread of the process, the periosteum exfoliates over a considerable extent, which can lead to malnutrition of the bone and its surface necrosis. Necrosis, capturing entire sections of the bone or the entire bone, is formed only when pus penetrates into the bone marrow cavities. The inflammatory process can stop in its development (especially with the timely removal of pus or when it breaks out on its own through the skin) or move to the surrounding soft tissues and to the bone substance.
The onset of purulent periostitis is usually acute, with fever up to 38-39 °, chills and an increase in the number of leukocytes in the blood (up to 10.0-15.0 × 109 / l).
In the area of the lesion, severe pain is noted, painful swelling is felt. With continued accumulation of pus, fluctuation is usually soon noted; surrounding soft tissues and skin may be involved in the process. The course of the process in most cases is acute, although there are cases of a primary protracted, chronic course, especially in debilitated patients. Sometimes there is an erased clinical picture without high temperature and pronounced local phenomena.
Allocate malignant, or acute, periostitis, in which the exudate quickly becomes putrefactive; swollen, gray-green, dirty-looking periosteum is easily torn, disintegrates. AT the shortest time the bone loses its periosteum and is wrapped in a layer of pus. After a breakthrough of the periosteum, a purulent or purulent-putrefactive inflammatory process passes like a phlegmon to the surrounding soft tissues.
Serous albuminous periostitis- an inflammatory process in the periosteum with the formation of exudate that accumulates subperiosteally and looks like a serous-mucous (viscous) fluid rich in albumin.
The exudate is surrounded by brown-red granulation tissue. Outside, the granulation tissue, together with the exudate, is covered with a dense membrane and resembles a cyst, which, when localized on the skull, can simulate a cerebral hernia. The amount of exudate sometimes reaches 2 liters. It is usually located under the periosteum or in the form of a racemose sac in the periosteum itself, it may even accumulate on its outer surface; in the latter case, diffuse edematous swelling of the surrounding soft tissues is observed. If the exudate is under the periosteum, it exfoliates, the bone is exposed and its necrosis may occur - cavities are formed filled with granulations, sometimes with small sequesters.
The process is usually localized at the ends of the diaphysis of long tubular bones, most often femur, less often the bones of the lower leg, humerus, ribs; young men usually get sick. Often, periostitis develops after an injury. A painful swelling appears, the body temperature initially rises, but soon becomes normal. When the process is localized in the joint area, a violation of its function may be observed. Initially, the swelling has a dense texture, but over time it can soften and fluctuate more or less clearly. The course is subacute or chronic.
Ossifying periostitis- a frequent form of chronic inflammation of the periosteum, which develops with prolonged irritation of the periosteum and is characterized by the formation of a new bone from a hyperemic and intensively proliferating inner layer of the periosteum. This process can be independent or, more often, accompanies inflammation in the surrounding tissues. Ossifying periostitis develops in the circle of inflammatory or necrotic foci in the bone (for example, osteomyelitis), under chronic varicose ulcers of the lower leg, in the circle of inflammatory-modified joints, tuberculous foci in the cortical layer of the bone. Severe ossifying periostitis is observed with syphilis. The development of reactive ossifying periostitis with bone tumors, rickets is known. The phenomena of ossifying generalized are characteristic of Bamberger - Marie periostosis, they can join the cephalhematoma.
After the cessation of irritations that cause the phenomena of ossifying periostitis, further bone formation stops; in dense compact osteophytes, internal restructuring of the bone (medullization) can occur, and the tissue takes on the character of a spongy bone. Sometimes ossifying periostitis leads to the formation of synostoses, most often between the bodies of adjacent vertebrae, between the tibia, less often between the bones of the wrist and tarsus.
Tuberculous periostitis is most often localized on the ribs and bones of the facial skull, where in a significant number of cases it is primary. The process often occurs in childhood. The course of tuberculous periostitis is chronic, often with the formation of fistulas, the release of purulent masses.
Syphilitic periostitis. Most lesions of the skeletal system in syphilis begin and are localized in the periosteum. These changes are observed in both congenital and acquired syphilis. By the nature of the lesion, syphilitic periostitis is ossifying and gummy. In newborns with congenital syphilis, there may be cases of ossifying periostitis in the diaphysis of the bones.
Changes in the periosteum in acquired syphilis can be detected already in the secondary period. They develop either immediately after the phenomena of hyperemia preceding the period of rashes, or simultaneously with the later returns of syphilides (usually pustular) of the secondary period, there are transient periosteal swellings that do not reach significant sizes, which are accompanied by sharp flying pains. The greatest intensity and prevalence of changes in the periosteum is reached in the tertiary period, and a combination of gummy and ossifying periostitis is often observed.
Ossifying periostitis in tertiary syphilis is usually localized in long tubular bones, especially in the tibia, and in the bones of the skull. As a result of periostitis, limited or diffuse hyperostoses develop.
With syphilitic periostitis, severe, aggravated pains at night are not uncommon. On palpation, a limited dense elastic swelling is detected, which has a spindle-shaped or round shape; in other cases, the swelling is more extensive and has a flat shape. It is covered with unchanged skin and is associated with the underlying bone; when palpating it, significant pain is noted. The most favorable outcome is the resorption of the infiltrate, observed mainly in recent cases. Most often, the organization and ossification of the infiltrate with neoplasms of bone tissue is observed. Less often, with a rapid and acute course, purulent inflammation of the periosteum develops; the process usually spreads to the surrounding soft tissues, the formation of external fistulas is possible.
Periostitis in other diseases. With glanders, there are foci of limited chronic inflammation of the periosteum. In patients with leprosy, infiltrates in the periosteum, as well as spindle-shaped swellings on the tubular bones due to chronic periostitis, may occur. With gonorrhea, inflammatory infiltrates develop in the periosteum, in case of progression of the process - with purulent discharge. Severe periostitis is described with blastomycosis of long tubular bones, ribs may be damaged after typhus in the form of limited dense thickenings of the periosteum with even contours. Local periostitis occurs with varicose veins of the lower leg, with varicose ulcers. Periostitis is also observed in rheumatism (the process is usually localized in the metacarpal and metatarsal, as well as in the main phalanges), diseases of the hematopoietic organs, with Gaucher's disease (periosteal thickenings mainly around the distal half of the femur). With prolonged walking and running, periostitis of the tibia may occur, which is characterized by severe pain, especially in the distal parts of the lower leg, aggravated by walking and exercise and subsiding at rest. Locally visible limited swelling due to swelling of the periosteum, very painful on palpation.
X-ray diagnostics. X-ray examination allows to reveal the localization, prevalence, shape, size, structure, outlines of periosteal layers, their relationship with the cortical layer of the bone and surrounding tissues. Radiographically, linear, fringed, comb-shaped, lacy, layered, needle-like and other types of periosteal layers are distinguished. In chronic, slowly ongoing processes in the bone, especially inflammatory ones, more massive stratifications are usually observed, as a rule, merging with the main bone, which leads to a thickening of the cortical layer and an increase in bone volume. Rapid processes lead to exfoliation of the periosteum with pus that spreads between it and the cortical layer, an inflammatory or tumor infiltrate. This can be observed in acute osteomyelitis, Ewing's tumor, reticulosarcoma. Smooth, even periosteal layers accompany the transverse pathological functional restructuring. In an acute inflammatory process, when pus accumulates under the periosteum under great pressure, the periosteum can rupture, and bone continues to be produced at the sites of ruptures, giving a picture of an uneven, torn fringe on the radiograph.
At rapid growth malignant tumor in the metaphysis of a long tubular bone, periosteal layers have time to form only in the marginal areas in the form of so-called peaks.
In the differential diagnosis of periosteal layers, it is necessary to keep in mind normal anatomical formations, for example, bone tuberosities, interosseous ridges, projections of skin folds (for example, along the upper edge of the clavicle), apophyses that have not merged with the main bone (along the upper edge of the iliac wing), etc. . It should also not be taken for periostitis by the deposition of calcium salts at the points of attachment of the tendons of the muscles to the bones. It is not possible to differentiate individual forms only) according to the x-ray picture.
Treatment may be conservative or operative. It is determined by the nature of the underlying pathological process and its course. So, for example, with syphilitic periostitis, specific treatment is usually carried out, and if gumma breaks out with the formation of an ulcer or bone necrosis, surgery may be required.
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Often a person, feeling pain in a leg or arm, thinks about or an ordinary bruise.
No one even suspects that pain in the leg and tooth pain can have one reason for such a manifestation.
It's all about such a disease as periostitis, about which ordinary people should know more information.
The concept and other characteristics of the disease
Periostitis - inflammation of the periosteum, leading to serious complications in case of untimely treatment.
The periosteum is closely connected with the bone, so the development of the disease affects the soft tissues. The inflammatory process can start on the outer layers or the inner ones, which leads to significant distinctive features and the nature of the treatment.
Inflammation often occurs on the jaw bones, which provokes an increase in the gums and subsequent suppuration. The simple name for this manifestation is flux. It can be easily cured through physiotherapy.
Periostitis of other bones occurs less frequently, but also contributes to the emergence of great dangers.
Causes of the disease
Inflammation of the periosteum is preceded by such aspects as:
- and contusions, or tendon ruptures;
- diagnosed allergic or rheumatic inflammations;
- toxins accumulated in the body internal organs and upper layers of bones;
- taking drugs with a high content of harmful chemical substances and toxins.
If a person falls into a risk group, he needs to see a doctor for examination at the first manifestations of periostitis - pain in the extremities.
Features of periostitis of the lower leg
The periosteum is a thin but dense membrane that covers the surface of the bone.
It contains great amount blood vessels and nerves.
Inflammation of the periosteum only at the initial stage is localized in the inner or outer layer of the membrane.
Subsequently, the inflammation grows and can affect the bone itself, which leads to osteoperiostitis.
In a particularly advanced case, inflammation already passes to the bone marrow, contributing to the occurrence.
In the photo, periostitis of the lower leg
Despite the above causes of the pathology, there are several features in the "vulnerability" of the periosteum.
Inflammation can provoke regular running on an asphalt or concrete road.
It should also be noted that most coaches claim the benefits of running on the forefoot.
As for the benefits of such a run for the legs, no positive aspect can be singled out here. This method of landing on a paved surface leads to inflammation of the periosteum.
Parkour is a modern hobby of young people, among whom there are many patients diagnosed with periostitis. The inflammation of the periosteum is affected by a sharp and hard landing on the foot during jumps. Here, direct blows to the lower leg often occur, which provokes the development of the disease.
Disease classification
The inflammatory process can be localized in different parts of the body.
Depending on the site of inflammation of the periosteum, periostitis is isolated:
- tibia;
- tibia;
- fibula;
- humerus;
- calcaneus;
- periostitis of the jaw;
- periostitis of the nasal bones.
The localization of the inflammation process directly affects the symptoms of the disease, as well as the choice of treatment methods. Signs and treatment also depend on the form of the disease.
Allocate chronic and acute forms of inflammation. Acute periostitis, characterized by purulent inflammation, often turns into a chronic course of the disease, since in most cases timely treatment is not provided.
Types of periostitis:
Types of disease can drastically change the standard course of treatment, especially if there is a change in them.
How to detect the disease in time?
The initial symptoms of periostitis include pain that occurs every time you move or palpate.
A person will not see any inflammation until a certain point. Such symptoms are attributed to a bruise or sprain.
Usually, the inflammatory process due to bruises and sprains ends 2-3 weeks after the injury.
The disease does not have the properties of self-elimination, therefore, if untimely drug treatment"gaining momentum" and changing shape.
At the next stage of its development, periostitis passes into a chronic ossifying form, where, through the growth of bone tissue, a person notices inflammatory foci with characteristic redness.
If measures are not taken in time and treatment is not started, the inflammation begins to suppurate, which leads to a purulent type of inflammation. In the affected area, the presence of ulcers and thickenings is noted.
The suppuration that has begun in the process of spreading affects the bone marrow, and this is fraught with lameness - there is a violation of the functions of the lower limb.
Diagnosis of the disease
When a patient comes to the clinic, the doctor conducts a complete and thorough examination.
Sometimes only one examination of a specialist can diagnose the onset of inflammation of the tibia. To make a diagnosis and the nature of the inflammation, some laboratory tests should be carried out, on the basis of which the doctor will determine the cause of the pathology that has arisen.
Here we check indicators such as:
- the level of immunoglobulins;
- check for the presence of rheumatoid factor;
- if you suspect the presence of syphilis or gonorrhea, PCR studies are performed;
- consider the index of C-reactive protein.
The patient then undergoes X-ray examination. It should be noted that the presented method is ineffective at the initial stages, because it helps to establish a diagnosis only after two weeks of the onset of the inflammatory process.
In rare cases, the patient is sent for a duplex ultrasound scan. It is used only in case of suspicion that the patient has varicose veins, which led to inflammation of the periosteum.
How to choose an effective therapy?
Treatment of periostitis assumes a complete absence of load on the leg during the first days or until the complete elimination of the presented disease.
The patient undergoes additional examination and treatment in the hospital.
Only in the initial stages of the development of periostitis, the doctor can allow treatment at home.
The treatment itself includes taking medications administered intramuscularly or intravenously, as well as in the form of tablets.
Here, anti-inflammatory and anti-allergic drugs are taken, calcium and vitamins are taken.
Additionally, physiotherapy is used:
- massage;
- application of dry heat;
- paraffin therapy;
- physiotherapy.
In no case should you self-medicate. The treatment regimen and the dosage of the medications used are prescribed only by the attending physician, who has conducted an appropriate examination and identified the type of disease.
In some cases, surgical intervention is used - with purulent inflammation, with the presence of purulent discharged clots. The tibia is not subjected to surgical intervention. Doctors make an incision on the leg and eliminate purulent accumulations.
Through the operation, recovery will take a longer time.
Complications and prevention of the disease
With untimely intervention or an error, purulent periostitis can lead to a chronic course of the disease and lead to the occurrence of diseases such as:
In order to prevent the described inflammation of the periosteum, it is necessary to follow the recommendations of a specialist, which are based on wearing only orthopedic shoes, with low heels and in size.
When playing sports, follow the instructions of the trainer and do not allow excessive stress on the legs.
If you feel pain in your leg, contact your doctor for a full examination and identification of the causes. The sooner periostitis is diagnosed and treated, the less time will be spent on recovery.