The clinical presentation of periostitis may depend on the underlying cause but in most cases, local pain and swelling of the adjacent tissue are present. Additional symptoms of fever, chills, and profound tenderness are suggestive of an infectious etiology, most notable being osteomyelitis, secondary syphilis, actinomycosis (when periostitis of the mandible is seen) or odontogenic infections [1]. In the setting of medial tibial stress syndrome (MTSS) (known as "shin splints”), inflammation of the periosteum leads to the appearance of vague and diffuse pain in the lower extremity, usually in the middle or distal tibia, which is provoked by exertion [2]. In the early stages, pain is worse when starting the exercise and then gradually decreases during training and within minutes of stopping the exercise. However, as the injury progresses, pain occurs with less activity and may even occur at rest. [2]. A similar clinical course can be observed in malignant or autoimmune diseases involving the skeletal system (e.g. leukemia, reactive arthritis, lung cancer with metastatic dissemination in the bones) [1] [3]. In rare cases, multifocal periostitis involving more than one extremity (or even the axial skeleton) and diffuse pain can be seen in patients who are receiving long-term prophylaxis of voriconazole, as this antifungal drug contains fluoride, which is known to induce a periosteal reaction [4] [5].

• Fever

  In a presence of an abscess patient will have high grade fever. [medicaljoyworks.com]

  In a presence of an abscess patient will have high grade fever[1][2]. [explainmedicine.com]

  OBJECTIVES: In 1966, Goldbloom et al. described two children who developed a peculiar clinical picture characterized by intermittent daily bone pain in the lower limbs, fever spikes, increased acute phase reactants and dysproteinaemia. [ncbi.nlm.nih.gov]

• Weakness

  Correcting underlying hip weakness, running mechanics, improper shoes, and other problems can also help. [health.uconn.edu]

  Several external factors may favor the appearance of shin splints, including: An inadequate shoe; A biomechanical disorder of the foot (flat foot or cavoid foot); A rapid increase in the intensity of physical activity; A lack of flexibility or muscle weakness [medicus.ca]

  Osteomyelitis is characterized by severe intoxication of the body, which is manifested by fever, fever, headaches, chills, weakness. [en.medicine-worlds.com]

  […] suggestive of cavernous sinus thrombosis Cavernous sinus thrombosis is a complication of orbital infections. patient will have headache, periorbital pain, swelling and cranial nerve palsy ( Eg; Lateral gaze palsy with isolated cranial nerve VI, eye muscle weakness [medicaljoyworks.com]

  […] tenderness lat to tibia over compartment; may be secondary to heel contact on hard surfaces wearing shoe with hard heel or biomechanical problems i.e forefoot varus - posteriomedial = symptoms along post/med border of mid lower tibia over post compartment - weakness [quizlet.com]

• Malaise

  Anotomy of orbit and related structures are very important in identifying the aetiology, symptoms and complications of orbital infections. fever, headache and other constitutional symptoms like malaise, lethargy, fatiguability fever, headache and other [medicaljoyworks.com]

  Secondary syphilis can present with a diverse range of symptoms including fever, malaise, headache, and rash. Uveitis, periostitis and osteomyelitis are less common. [jucm.com]

  Anotomy of orbit and related structures are very important in identifying the aetiology, symptoms and complications of orbital infections[1][2][3]. fever, headache and other constitutional symptoms like malaise, lethargy, fatiguability fever, headache [explainmedicine.com]

  There was no history of trauma, fever, or malaise. A radiograph of the right leg was reported to show a periosteal reaction at the lateral aspect of the femur consistent with a fracture. [adc.bmj.com]

• Sore Throat

  They may also experience pruritus, sore throats or headaches.6 On physical exam, nearly all patients with secondary syphilis will have dermatologic findings, although up to 25% may be unaware of any rash (source). [jucm.com]

• Flushing

  Common side effects of short-term prostaglandin therapy include apnea, fever, convulsions, rash, skin flushing, vasodilatation with hypotension, diarrhea, and gastric outlet obstruction. [roentgenrayreader.blogspot.com]

• Bone Pain

  Awareness of this potential syndrome, which manifests as bone pain, elevated serum alkaline phosphatase and a bone scan suggestive of periostitis, is necessary in LT recipients on long-term voriconazole. [ncbi.nlm.nih.gov]

• Medial Tibial Stress Syndrome

  Medial tibial stress syndrome: conservative treatment options, Curr Rev Musculoskelet Med, 2009; 2 : 127-133. 3 Hamstra-Wright KL, et al.. [kinatex.com]

  Treatment of medial tibial stress syndrome: a systematic review. Sports Med. 2013 Dec;43(12):1315-33. Max Pietrzak. Diagnosis and management of acute medial tibial stress syndrome in a 15 year old female surf life-saving competitor. [danielebarnabei.it]

  Medial Tibial Stress Syndrome. The Location of Muscles in the Leg in Relation to Symptoms. The Incidence and Risk Factors in the Development of Medial Tibial Stress Syndrome Among Naval Recruits. [wheelessonline.com]

  Abstract Medial tibial stress syndrome is characterised by complaints along the posteromedial tibia. Runners and athletes involved in jumping activities may develop this syndrome. [ncbi.nlm.nih.gov]

• Lower Leg Pain

  All medical data were gathered from enrolled adults with sports-related lower leg pain. A total of 54 patients underwent triple-phase bone scans using skeletal nuclear scintigraphy, which confirmed periostitis in their lower limbs. [ncbi.nlm.nih.gov]

  They include: tendonitis, a partial muscle tear, growth plate inflammation, referred lower back pain, lower leg muscle imbalance, a leg length difference and compartment syndrome. Compartment syndrome can occur in muscles originating from the tibia. [painfreefeet.ca]

• Bony Swelling

  Periostitis deformans is an uncommon condition of the skeletal system, mainly manifested as bone pain with or without bony swellings. [ncbi.nlm.nih.gov]

  Second metacarpal bone bears more weight than fourth metacarpal/metatarsal bone and is more prone to the formation of bony swellings or splints. [vetstream.com]

• Bone Disorder

  The book details the pathologic and radiologic characteristics of all bone and joint diseases, including arthritis, metastatic bone disease, osteoporosis, trauma, osteomyelitis, developmental bone disorders, and tumor-like lesions. [books.google.com]

Patient history is quite important in evaluating the etiology and course of the disease-causing the symptoms reported by the patient, especially when information such as recent voriconazole use or presence of malignant diseases are obtained. The diagnosis of periostitis as an isolated finding, however, can only be made through imaging studies. Radiography is an easy, effective and quick method to detect some of the key features that support the diagnosis. Irregular nodular calcifications along the interosseous membrane, edema of the periosteum, the presence of exostoses (an exuberant growth of periosteal bone due to inflammation), gross thickening of the affected bones, and a periosteal reaction of various types (single layer, onion skin, sunburst type, etc) are the main findings [2] [5] [6]. In fact, the type of periosteal reaction can be helpful, as "onion skin" type is typical for periostitis ossificans, a type of non-suppurative osteomyelitis [7], and for malignant neoplasms (Ewing's sarcoma, for example), whereas "sunburst" reaction is primarily encountered in benign tumors, such as osteoblastoma [3] [8]. More advanced imaging studies - magnetic resonance imaging (MRI) or computed tomography (CT), or nuclear bone scanning, can be useful for determination of the cause, and to assess the state of the surrounding soft tissue [2].

We describe a case of development of painful periostitis deformans in a 39-year-old woman who was receiving long-term voriconazole treatment for Aspergillus infection as a complication of orthotopic liver transplant. [ncbi.nlm.nih.gov]

The prognosis for returning to perform at her previous level of activity without ongoing lameness problems in the right forelimb remained fair to guarded. [cal.vet.upenn.edu]

What is the prognosis for a person with peritonitis? The prognosis for individuals who develop peritonitis depends on both the underlying cause and how rapidly the disease is treated. The prognosis can range from good to poor. [medicinenet.com]

This is a relatively benign disease and has a good prognosis but continued insults may cause chronic pain and discomfort. [healthhema.com]

Prevention and prognosis of periostitis Prognosis for periostitis is good as long as treatment is completed. For those with acute periostitis, surgery may be performed and antibiotics administered through IV. [belmarrahealth.com]

It needs no pharmacological or surgical treatment and has an excellent prognosis. References 1. Rana RS, Jim SW, Ronald LE. Periosteal reaction. AJR Am J Roentgenol 2009; 193:259-72. 2. James HB, Charles AR, James RK. Basic principles. [wajradiology.org]

Mandibular cases were already described for an infectious dental cause, often with an "onion skin" radiographic aspect, but some rare reported cases showed no obvious etiology. [ncbi.nlm.nih.gov]

Additional symptoms of fever, chills, and profound tenderness are suggestive of an infectious etiology, most notable being osteomyelitis, secondary syphilis, actinomycosis (when periostitis of the mandible is seen) or odontogenic infections. [symptoma.com]

Detailed lesion descriptions and over 300 photographs and diagrams facilitate disease recognition and each condition is placed in context with discussion of its history, antiquity, etiology, epidemiology, geography, and natural history. [books.google.com]

Epidemiology The number of syphilis cases peaked in the United States in the late 1980s and early 1990s. [jucm.com]

Definition, pathogenesis, and epidemiology Peritonitis is defined as inflammation of the peritoneum, which may be caused by pathogens or non-pathogenic factors, e.g., barium enema. [ncbi.nlm.nih.gov]

"Noncontiguous and open fractures of the lower extremity: Epidemiology, complications, and unplanned procedures". Injury. 47 (3): 742–747. doi:10.1016/j.injury.2015.12.013. [en.wikipedia.org]

Epidemiology The overall incidence of peritoneal infection and abscess is difficult to establish and varies with the underlying abdominal disease processes. [emedicine.medscape.com]

Pathology and Pathophysiology of this disease are described in a clear way. All therapeutic modalities from surgery to antibiotic and hyperbaric oxygen therapy are comprehensively outlined and discussed. [books.google.com]

Pathophysiology Injury to interosseous ligament due to instability between MC/MT 2 and 4 and MC/MT 3 → desmitis and proliferative new bone formation. [vetstream.com]

A study was performed to determine the frequency of periosteal reaction associated with chondroblastoma, to investigate the underlying pathophysiology of the periosteal reaction, and to postulate the clinical importance of this radiographic observation [mayoclinic.pure.elsevier.com]

Although POPP is considered to be a type of psoriatic arthritis, its pathology and pathophysiology are poorly understood. [escholarship.org]

(See Pathophysiology.) Did this answer your question? Yes No Additional feedback? (Optional) Thank you for your feedback! Leppaniemi A, Kimball EJ, De Laet I, Malbrain ML, Balogh ZJ, De Waele JJ. Management of abdominal sepsis--a paradigm shift?. [medscape.com]

This prevents the transmission of the infection to other tissues. Treatment of root canals is therefore crucial to prevent and completely eliminate inflammation. For preventive reasons, tooth extraction (pulling teeth) is sometimes necessary. [schill.sk]

Early recognition of this phenomenon is important to prevent unnecessary tests and procedures. Prompt discontinuation of voriconazole should result in improvement of symptoms. [ncbi.nlm.nih.gov]

By treating minor injuries right away, you can prevent chronic periostitis from occurring. Prevention of chronic periostitis involves preventing overuse injuries. [belmarrahealth.com]

1. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
2. Galbraith RM, Lavallee ME. Medial tibial stress syndrome: conservative treatment options. Curr Rev Musculoskelet Med. 2009;2(3):127-133.
3. Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 18e. New York, NY: McGraw-Hill; 2012.
4. Wermers RA, Cooper K, Razonable RR, et al. Fluoride excess and periostitis in transplant patients receiving long-term voriconazole therapy. Clin Infect Dis. 2011;52(5):604-611.
5. Skaug M, Spak C, Oza U. Painful periostitis in the setting of chronic voriconazole therapy. Proc (Bayl Univ Med Cent). 2014;27(4):350-352.
6. Shah KM, Karagir A, Adaki S. Chronic non-suppurative osteomyelitis with proliferative periostitis or Garre's osteomyelitis BMJ Case Rep. 2013;2013: bcr2013009859.
7. Kannan SK, Sandhya G, Selvarani R. Periostitis ossificans (Garrè's osteomyelitis) radiographic study of two cases. Int J Paediatr Dent. 2006;16(1):59-64.
8. Sharma V, Chew FS, Hoch B. Periosteal osteoblastoma: Multimodal imaging of a rare neoplasm. Radiol Case Rep. 2009;4(4):329.