Diagnosis: Clinical
Osteomyelitis should be diagnosed clinically with a high index of suspicion
- Fever
- Bone Pain
- Reduced Mobility
- Local Erythema
- Tenderness
- Warmth
- Swelling
By the time changes on X-ray are present the disease is already advanced
A high suspicion of osteomyelitis should be given to those patients at risk of developing OM (diabetics, IVDU, immunosuppressed).
Diagnosis and treatment should be started on clinical suspicion as waiting for changes to X-ray may take a long time, by which point the disease process is already extensive.
The typical clinical signs are standard for infection, redness, warmth, swelling, pain, fever and reduced mobility. It's important to localise the site of the pain and where the reduced mobility is coming from as if its localised around a joint then septic arthritis or bursitis is more likely to be a differential.
On examination its important to ask if the patient can weight bear and localise where the pain is coming from, also to rule out any traumatic causes of the pain and reduced ROM. Thorough examination is key and its important to break it down and isolate the area of tenderness and pain, being careful not to miss out any possible septic arthritis as if this is missed you will cripple your patient.
