Periostitis

Periostitis is an inflammatory process that occurs in the periosteum of the bone.

The periosteum is a connective tissue in the form of a film that is located over the entire surface outside the bone. As a rule, the inflammatory process begins in the outer or inner layers of the periosteum, and then penetrates into its other layers.

Due to the fact that the periosteum and bone are closely connected, inflammation easily appears in bone tissue and is called osteoperiostitis.

ICD-10 code

ICD is an international classification of diseases and various problems associated with health disorders.

Currently, the tenth version of the International Classification of Diseases document, called ICD-10, is in effect in the world.

Different types of periostitis received their own codes in this classification:

Periostitis of the jaws – belongs to class K10.2 – “Inflammatory diseases of the jaws”:

• K10.22 - purulent, acute periostitis of the jaw
• K10.23 - chronic periostitis of the jaw

Class M90.1 – “Periostitis in other infectious diseases classified elsewhere”:

• M90.10 – multiple localization of periostitis
• M90.11 – periostitis localized in the shoulder region (clavicle, scapula, acromioclavicular joint, shoulder joint, sternoclavicular joint)
• M90.12 – periostitis localized in the shoulder (humerus, elbow joint)
• M90.13 – periostitis localized in the forearm (radius, ulna, wrist)
• M90.14 – periostitis localized in the hand (wrist, fingers, metacarpus, joints between these bones)
• M90.15 – periostitis localized in the pelvic region and thigh (gluteal region, femur, pelvis, hip joint, sacroiliac joint)
• M90.16 - periostitis localized in the leg (fibula, tibia, knee joint)
• M90.17 – periostitis localized in the ankle joint and foot (metatarsus, tarsus, toes, ankle joint and other joints of the foot)
• M90.18 – other periostitis (head, skull, neck, ribs, trunk, spine)
• M90.19 - Periostitis of unspecified site

Causes of periostitis

The causes of periostitis are the following:

1. Various types of injuries – bruises, dislocations, bone fractures, ruptures and stretching of tendons, wounds.
2. Inflammation of nearby tissues - as a result of the occurrence of an inflammatory focus near the periosteum, infection of the periosteum occurs.
3. Toxic - these are the reasons that represent the effect of toxins on the periosteum tissue. Some types of common diseases can provoke the appearance of toxins in the patient's body and their penetration into the periosteum. Toxins enter the blood and lymphatic systems from the diseased organ and are carried throughout the body with their help.
4. Specific – inflammation of the periosteum occurs as a result of certain diseases, such as tuberculosis, syphilis, actinomycosis, and so on.
5. Rheumatic or allergic - a reaction of the periosteal tissue to allergens that have penetrated it.

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Pathogenesis of periostitis

The pathogenesis of periostitis, that is, the mechanism of its occurrence and progression, can be of several types.

1. Traumatic periostitis – occurs as a consequence of all kinds of bone injuries affecting the periosteum. Traumatic periostitis can manifest itself in an acute form, and then, if treatment is not provided in time, turn into a chronic form.
2. Inflammatory periostitis is a type of periostitis that occurs as a result of inflammation of other nearby tissues. For example, this type of periostitis is observed in osteomyelitis.
3. Toxic periostitis – occurs as a result of the impact of toxins on the periosteum, entering it with the blood or lymph flow from other lesions. This type of periostitis appears with some general diseases of the body.
4. Rheumatic or allergic periostitis – occurs as a result of allergic reactions of the body to certain factors.
5. Specific periostitis is caused by certain diseases, such as tuberculosis, actinomycosis, and so on.

Symptoms of periostitis

Symptoms of periostitis depend on the type of periostitis. Let's consider the body's reaction to aseptic and purulent periostitis.

Symptoms of aseptic periostitis are as follows:

1. Acute aseptic periostitis is characterized by the appearance of swelling, which is weakly limited. When palpating the swelling, severe pain occurs. At the same time, the local temperature in the affected area increases. When this form of periostitis appears on the limbs, lameness of the supporting type may be observed, that is, a violation of the supporting function.
2. Fibrous periostitis is characterized by a limited form of swelling. At the same time, it has a dense consistency and is practically painless or does not cause pain at all. The local temperature in the affected area remains unchanged. And the skin over the lesion becomes mobile.
3. Ossifying periostitis manifests itself in swelling that has sharply defined outlines. Its consistency is hard, sometimes with an uneven surface.

There is no pain, and the local temperature remains normal.

In all types of aseptic periostitis, the body's general reaction to the onset of the disease is absent.

In purulent periostitis, a different reaction of the body is observed. Manifestations of purulent periostitis are characterized by severe local disorders and changes in the condition of the entire body. An increase in body temperature is observed, the patient's pulse and breathing quicken, appetite disappears, weakness, rapid fatigue and a general depressed state appear.

The swelling is very painful, hot, and there is increased tension in the tissues of the inflamed area. Soft tissue edema may occur at the site of periosteal inflammation.

Periostitis of the jaw

Periostitis of the jaw is an inflammatory process occurring in the alveolar process of the upper jaw or the alveolar part of the lower jaw. Periostitis of the jaw occurs due to diseased teeth: untreated or undetected periodontitis or pulpitis. Sometimes the inflammatory process begins due to infection from other diseased organs with the blood or lymph flow. If treatment is not done in time, periostitis provokes the occurrence of a fistula (or flux) on the gum. Purulent inflammation can spread from the periosteum to the tissues that surround the lesion, resulting in an abscess or phlegmon.

Periostitis of the tooth

Periostitis of the tooth is a type of periostitis, in which there is an inflammatory process of the tooth tissues, which is commonly called gumboil. This disease occurs mainly due to untreated tooth decay. As a result, the infection penetrates the tooth, causing periostitis.

Periostitis of the tooth is accompanied by strong unpleasant symptoms, the main one being a strong unbearable toothache. Local or general body temperature, chills and weakness may also appear.

Periostitis of bone

Periostitis of bone or osteoperiostitis is an inflammation of bone tissue caused by inflammatory processes in its periosteum. Since the tissues of the periosteum and bone are adjacent to each other, the lesions expand.

Osteoperiostitis can be caused by pathogenic microorganisms. Diseases of an infectious nature are one of the causes of bone periostitis. These diseases that provoke osteoperiostitis include: osteomyelitis, bone tuberculosis, syphilis and other diseases.

Periostitis of the periosteum

This is an inflammatory disease of the periosteum, which is caused by various injuries or infection of a certain part of the periosteum.

The causes of periostitis of the periosteum can be various bruises, sprains and ligament ruptures, bone fractures, which result in inflammation of the periosteum.

Also, inflammation of the periosteum can be of infectious nature, for example, when pathological microflora enters the injured area. Also, various infectious diseases can contribute to the appearance of periostitis, when pathogenic microorganisms enter the periosteum from the site of inflammation with the help of blood or lymph flow.

Periostitis of the leg

This is an inflammatory lesion of the periosteum of the leg bones. Usually, they occur as a result of various leg injuries - soft tissue bruises, ligament sprains, bone fractures, joint dislocations, etc. Injuries of various types cause mechanical damage to the periosteum of the leg bones, and then its inflammation.

The tibia is most susceptible to periostitis. This bone suffers most from injuries in athletes and soldiers in the early period of service. Running on hard ground, rough terrain, etc. can injure the tibia and its periosteum. As a result, acute or chronic forms of aseptic periostitis may occur.

At the very beginning of the disease, a small swelling appears on the back surface of the first third of the shin, which causes painful sensations in the leg when palpated. At the beginning of the disease, X-ray examination does not reveal any changes in the bone. But after twenty or thirty days, small seals can be seen on the images on the inner surface of the tibia.

Periostitis of the leg

An inflammatory process that appears in the periosteum of the leg. The lesion appears in the outer or inner layers of the periosteum and then spreads to all tissues of the periosteum.

The causes of periostitis of the leg are:

• injuries – bruises, bone fractures, tendon strains;
• biomechanical problems, most often excessive pronation;
• training errors and excessive loads;
• incorrectly selected shoes;
• unevenness of the surface on which training is carried out, usually in running.

The first symptoms of periostitis of the shin periosteum are swelling. Infectious periostitis may be accompanied by pain in the affected area and an increase in body temperature.

Periostitis of the knee joint

Inflammatory processes in the periosteum of the bones that form the knee joint. This occurs as a result of injury to the joint capsule, stretching and rupture of the joint ligaments. Inflammation of the periosteum leads to swelling on the bone, which is painful to palpation. Edema of the adjacent tissues appears, which makes it difficult to move the joint.

Usually, periostitis of the knee joint develops into a chronic form, which provokes the formation of various growths and compactions on the bone, which impede movement. Also, periostitis of the knee joint is most often accompanied by manifestations of osteoperiostitis of the bones that form this joint.

Periostitis of the foot

Lesions of the periosteum of the bones of the feet of an inflammatory nature. The most common causes of periostitis of the foot are injuries (bruises, dislocations, stretching and ligament ruptures). Constant loads also relate to the causes of periostitis of the foot - as a result of constant irritation of the periosteum and microtraumas, inflammatory processes and changes in the tissues of the periosteum occur.

Periostitis of the foot is accompanied by the following symptoms: sharp pain when putting weight on the foot, swelling of soft tissues, thickening of the bones of the foot, which can be painful or painless when palpated.

Periostitis of the metatarsal bone

This is an inflammatory process in the periosteum of one metatarsal (metacarpal) or several metatarsal (metacarpal) bones. Metatarsal bone periostitis usually occurs as a result of an injury (traumatic periostitis) or constant loads on the metatarsal bones (load-bearing periostitis).

Periostitis of the metatarsal bones also occurs as a complication of longitudinal flatfoot. Or in women who constantly wear high heels.

The main symptoms of periostitis of the metatarsal bone are the appearance of sharp pain, especially when putting weight on the foot or walking; swelling of the feet; the appearance of seals when palpating the metatarsal bones.

Periostitis of the nose

Inflammatory processes that form in the periosteum of the sinus bones. Most often, the occurrence of such periostitis is associated with previous injuries. For example, a fracture of the nasal bones can subsequently lead to inflammation of the periosteum. Also, inflammation of the periosteum can be caused by inflammatory processes occurring in the sinuses and other parts of the nasopharynx.

Symptoms of periostitis of the nose include changes in its shape and the appearance of pain, which intensifies when palpating the nose.

When diagnosing periostitis, it is important to establish the injury or ongoing injuries, for example in athletes – boxers.

Periostitis of the orbit

These are inflammatory processes in the periosteum (periosteum) of the orbit. Usually, orbital periostitis appears together with bone inflammation and is called osteoperiostitis.

Periostitis of the orbit appears in different areas. Usually, it is serous or purulent, sometimes with the appearance of an abscess.

The causes of the disease can be pathogenic microorganisms - streptococci, staphylococci, and, in rarer cases, tuberculosis mycobacteria and spirochetes.

Most often, orbital periostitis appears as a complication of inflammation of the nasal sinuses and the appearance of furuncles on the face. Sometimes orbital periostitis is caused by infectious diseases - tonsillitis, flu, scarlet fever, measles, etc. Among the causes of orbital periostitis can also be dental caries, dacryocystitis and trauma to the orbital periosteum.

The manifestations of periostitis in this case are as follows: swelling in the anterior parts of the orbit, which is painful when pressed; edematous skin in this area, which has a higher temperature compared to the neighboring ones; swelling of the mucous tissue of the eyelids; conjunctivitis.

The disease may be acute – developing within two or three days. It may also be sluggish, lasting for several weeks.

Orbital periostitis

Another name for orbital periostitis. There are two forms of orbital periostitis:

• Simple or non-purulent.
• Purulent.

Simple orbital periostitis occurs as a result of acute inflammation of the nasal sinuses, which were the consequences of flu, scarlet fever and other infectious diseases. This process is reversible and is the appearance of hyperemia and serous-cellular infiltration of the periosteum. Externally, this looks like a small swelling of the periosteum. Under favorable conditions for the development of periostitis, a connective callus is formed on the orbital bone, localized on the periosteum. Then the periosteum fuses with the bone, that is, a fibrous callus is formed.

Purulent periostitis is a consequence of simple periostitis or is provoked by existing deep caries of the bone wall of the accessory cavity. Purulent periostitis is manifested by the formation of pus from serous-cellular infiltration of the periosteum. Initially, these manifestations occur on the inner surface of the periosteum, which is connected to the bone. Subsequently, the pus that accumulated between the periosteum and the bone begins to saturate the inner layer of the periosteum, which peels off from the bone and an abscess occurs in this place.

Periostitis in children

Periostitis in children is a manifestation of inflammatory processes in the periosteum of the jaws. The nature of the disease can be odontogenic or traumatic. The odontogenic nature of periostitis is associated with dental diseases, when the infection gets into the periosteum from the inflamed periodontium. Traumatic periostitis appears as a result of jaw injuries.

According to the nature of the disease, periostitis in children can be acute and chronic. Acute periostitis, in turn, is divided into purulent and serous. Chronic periostitis in children is rare, usually acute periostitis occurs in childhood.

Classification of periostitis

There are several types of classification of periostitis.

There are several types of periostitis, which depend on the nature of the inflammatory processes and the reasons for their occurrence. The first group of periostitis is exudative, these include serous, serous-fibrinous, fibrinous and purulent periostitis. The second group of periostitis is proliferative, these include fibrous and ossifying periostitis. Exudative periostitis usually has an acute and rapid course, and proliferative ones are always chronic.

1. Simple.
2. Ossifying.
3. Purulent.
4. Serous albuminous.
5. Fibrous.
6. Tuberculous periostitis is characterized by the appearance of granulated affected tissue in the inner layer of the periostitis. This tissue then changes into cheesy necrotic manifestations or is subject to purulent melting, as a result of which the periosteum is destroyed. Usually this type of periostitis appears on the ribs and facial bones.
7. Syphilitic - a lesion of the periosteum that occurs as a result of syphilis, which can be congenital or acquired. Syphilitic periostitis comes in two forms - ossifying and gummatous. The ossifying form is characterized by the occurrence of hyperostoses (syphilitic nodes on the periosteum). Gummatous periostitis provokes the appearance of gummas on the bones - elastic flat thickenings.

Depending on the duration of the disease, there are two forms of periostitis:

1. Acute (subacute).
2. Chronic.

Depending on the involvement of microorganisms in the inflammatory processes that arise, periostitis is distinguished:

1. Aseptic – appear as a result of closed bone injuries in places that are not protected by soft tissues.
2. Purulent - are the result of various infections entering the periosteum.

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Acute periostitis

Acute periostitis is a type of periostitis in which the course of the disease manifests itself in an acute form with purulent inflammatory processes. The occurrence of acute periostitis is caused by the penetration of pathogenic microflora into the periosteum.

The first signs of acute periostitis are the appearance of swelling on the periosteum and edema of soft tissues. The appearance of these symptoms is accompanied by painful sensations in the swelling, which quickly increases in size. Subsequently, the swelling is transformed into purulent inflammation, the course of which is characterized by an increase in body temperature to 38 - 39 degrees.

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Chronic periostitis

This is a long-term and slowly progressing inflammatory process of the bone periosteum. Chronic periostitis is characterized by the appearance of a thickening on the bone, which does not cause pain.

X-ray examination revealed that chronic periostitis manifests itself in lesions that have clear boundaries. In this case, pathological changes in bone tissue of moderate severity and the appearance of severe hyperplasia in the periosteum are observed.

The development of chronic forms of periostitis is caused by untreated acute periostitis, which has transformed into a chronic disease. There are cases when chronic periostitis does not pass the acute stage, but immediately turns into a sluggish, long-term disease.

Also, the development of chronic periostitis can be facilitated by specific inflammatory infectious diseases (tuberculosis, syphilis, osteomyelitis, etc.), which lead to complications, for example, to the appearance of a chronic form of periostitis.

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Simple periostitis

An acute inflammatory process of an aseptic nature, in which there is an increased blood flow to the affected part of the periosteum (hyperemia), as well as a slight thickening of the periosteum and the accumulation of fluid in its tissues that is not characteristic of it (infiltration).

Purulent periostitis

The most common form of periostitis. Occurs as a result of injury to the periosteum and the appearance of infection in it, most often from neighboring organs. For example, purulent periostitis of the jaw occurs due to dental caries, when inflammation is transferred from the bones to the periosteum. Sometimes this type of periostitis occurs hematogenously, for example, with pyemia. Purulent periostitis always accompanies the manifestation of acute purulent osteomyelitis. Sometimes, it happens that the source of the infection cannot be detected.

Purulent periostitis begins with an acute condition. Hyperemia of the periosteum develops, in which exudate is formed - a liquid saturated with proteins and blood elements. A high body temperature of about 38 - 39 degrees, chills appear. A thickening is palpated in the affected area, which is painful when pressed. After this, purulent infiltration of the periosteum occurs, as a result of which it is easily rejected from the bone. The inner layer of the periosteum becomes loose and filled with pus, which then accumulates between the periosteum and the bone, forming an abscess.

With purulent periostitis, inflammation of the soft tissues and skin of the patient associated with the periosteum may occur.

Serous periostitis

Serous (albuminous, mucous) periostitis occurs after various injuries. A swelling appears on the injured area of the periosteum along with painful sensations in it. At the beginning of the disease, the body temperature rises and then normalizes. If the inflammatory process is observed in the joint area, this can lead to a decrease in its mobility. In the first stage of serous periostitis, the swelling has a dense consistency, but then softens and can become liquid.

There are subacute and chronic forms of serous periostitis. In each of these cases, inflammation of the periosteum leads to the formation of exudate, which is localized under the periosteum in a sac similar to a cyst or in the periosteum itself. It has the appearance of a serous-mucous viscous fluid. It contains albumins, as well as inclusions of fibrin flakes, purulent bodies and cells in a state of obesity, erythrocytes. Sometimes the fluid contains pigments and fat droplets. The exudate is in a shell of granulated tissue of a brown-red color, and is covered with a dense shell on top. The amount of exudate can reach two liters.

If exudate accumulates on the outer surface of the periosteum, it can cause edema of the soft tissues, manifested in their swelling. Exudate, which is located under the periosteum, provokes its detachment from the bone. This leads to the bone being exposed and necrosis occurs, when cavities appear in the bone filled with granular tissue and microorganisms with weakened virulence.

Fibrous periostitis

Fibrous periostitis has a chronic course and a long-term process of damage. It develops over many years and is characterized by the appearance of a callused fibrous thickening of the periosteum, which is strongly associated with the bone. If fibrous deposits are significant, this can lead to the destruction of the bone surface or the appearance of new formations on it.

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Linear periostitis

This is the periostitis configuration that is revealed on X-ray examination. Linear periostitis on X-ray image looks like a single line located along the bone. There is a linear darkening in the form of a strip (ossification) along the bone edge. This form of periostitis is observed in the inflammatory process that develops slowly and gradually. For example, linear periostitis is observed in syphilis that occurs at an early age, in childhood or in the initial phase of bone inflammation (osteomelitis).

In acute periostitis, a dark linear darkening is separated from it by a light area. This may be exudate, osteoid or tumor tissue. Such manifestations on an X-ray image are characteristic of acute inflammatory periostitis - acute periostitis, exacerbation of chronic osteomyelitis, the primary stage of the appearance of bone callus in the periosteum or a malignant tumor.

With further observation, the light stripe may become wider, and the dark one may disappear altogether. Such manifestations are characteristic of hyperostosis, when formations in the periosteum merge with the cortical layer of the bone.

Ossifying periostitis

It occurs due to simple periostitis as a result of constant irritation of the periosteum and is a chronic form of this disease. It is characterized by the deposition of calcium salts in the periosteum and the formation of new bone tissue from the inner layer of the periosteum. This type of periostitis can occur independently or be accompanied by inflammation of the surrounding tissues.

Retromolar periostitis

A disease caused by acute pericoronitis. As the disease progresses, inflammation of the periosteum in the retromolar region occurs.

Later, an abscess develops under the periosteum, along the edges of which inflammation of the soft tissues occurs. The area of the pterygomaxillary fold, the anterior palatine arch, the soft palate, the anterior edge of the jaw branch, the mucous membrane of the fold above the external oblique line in the area of the sixth to eighth teeth are affected. Sore throat may occur.

A few days after the abscess appears, pus begins to appear from under the inflamed membrane near the eighth tooth. Sometimes the abscess does not open in this area, but spreads along the external oblique line to the level of the premolars and forms a fistula in this area. Sometimes the abscess can open in the maxillo-lingual groove, also in the form of a fistula.

The acute phase of retromolar periostitis is accompanied by an increase in body temperature to 38 - 38.5 degrees, trismus of the jaws, difficulty in eating as a result, and the appearance of weakness. The acute form of periostitis, if left untreated, turns into a chronic phase, which is accompanied by the development of acute cortical osteomyelitis of the jaw.

Odontogenic periostitis

Odontogenic periostitis is an inflammatory process in the jaw bones, which manifests itself in inflammation of the periosteum of the jaws. Odontogenic periostitis occurs due to the penetration of infection from the inflamed tissues of the tooth into the periosteum of the jaw. Such lesions occur as a result of certain dental diseases - caries, pulpitis and periodontitis. The inflammatory process penetrates from the diseased tooth first into the bone that surrounds it, and then to the periosteum, which covers the bone tissue.

Sometimes odontogenic periostitis occurs due to increased blood supply and lymph supply to the pulp, jaw bones and soft tissues during the period of tooth formation, eruption and replacement, as well as the growth of the jaw bones during this period.

Load-bearing periostitis

This is an inflammatory process of the periosteum of bones that are subject to regular increased loads. For example, load-bearing periostitis appears on the bones of the foot and shins when the patient has to be on his feet for a long time - standing, walking or running. This type of periostitis occurs in athletes involved in track and field; weightlifters; people whose work involves constantly carrying heavy objects.

Load-induced periostitis can occur due to injuries, such as dislocations.

Symptoms of load-related periostitis include the occurrence of pain when putting weight on the legs, swelling of the legs, and the appearance of hardening of the bone when palpated.

Traumatic periostitis

Periosteal injury (traumatic periostitis) is an inflammatory disease of the periosteum that occurs as a result of some kind of injury. This type of periostitis is most common in athletes and people who train regularly.

It occurs as a result of a bruise of the soft tissues covering the bone (i.e. the periosteum), when the blow falls on a part of the bone that is poorly protected by the muscles surrounding it.

Traumatic periostitis may be a consequence of other diseases, such as tuberculosis, osteomyelitis, syphilis, malignant tumors, etc. Since these diseases lead to mechanical damage to the periosteum, an aseptic inflammatory process occurs.

Traumatic periostitis has two forms of progression: acute and chronic.

The clinical picture of the acute form of the disease is very similar to the manifestations of bruises. A bruise and swelling form at the site of injury, which is painful when pressed. Edema of nearby tissues may occur, as well as prolonged pain. When examining the patient, a dense thickening is palpated on the bone. This type of periostitis is most typical for injuries to the tibia.

The chronic form of traumatic periostitis is manifested by thickening of the cortical layer of the bone. The formation of osteophytes (growths on the marginal tissue of the bone) and synostoses (fusion of adjacent bones) is also possible.

Post-traumatic periostitis

This is a type of periostitis that occurs as a consequence of trauma after a bone contusion. Also, after fractures, sprains and other injuries, symptoms of post-traumatic periostitis may appear.

In this case, an aseptic inflammatory process occurs in the periosteum, which can lead to acute manifestations of periostitis or develop into a chronic form. The manifestations of post-traumatic periostitis are similar to the symptoms of traumatic periostitis described earlier.

Complications of periostitis

Complications of purulent periostitis are quite severe. If you do not start treating it in time, it can lead to inflammatory processes and destruction of nearby tissues and organs, as well as the entire body.

Purulent periostitis can provoke the appearance of such diseases as:

1. Osteomyelitis is an inflammatory process of a purulent nature, which leads to necrosis of all bone tissues, bone marrow, and soft tissues surrounding the bone.
2. Phlegmon of soft tissues located near the affected bone. This disease is characterized by the spread of pus and inflammation of the cellular spaces and does not have clearly defined boundaries.
3. A soft tissue abscess is a purulent inflammation with a clear location and boundaries.
4. Mediastinitis is an acute inflammation of the mediastinum associated with the penetration of infection.
5. Sepsis is a general, serious condition of the body caused by the entry of pathogens of animal origin and their toxins into the patient’s blood and tissues.

Acute periostitis can become chronic if treatment is not carried out or if errors occur during treatment procedures.

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Diagnosis of periostitis

Diagnosis of periostitis varies depending on its type and course.

In acute periostitis, a thorough examination and questioning of the patient are effective. An important aspect of diagnostics is the results of a general blood test. X-ray examination is ineffective in this case. Rhinoscopy is used for nasal periostitis.

In chronic periostitis, X-ray examination is used. An X-ray image can be used to identify the location of the lesion, its shape and boundaries, size, and the nature of the layers. The image helps to identify the degree of inflammation penetration into the cortical layer of the bone and surrounding tissues, as well as the degree of necrotic changes in bone tissue.

The periostitis layers can be of different shapes – needle-shaped, linear, lacy, fringed, comb-shaped, layered and others. Each of these shapes corresponds to a certain type of periostitis and the complications it causes, as well as associated diseases, such as a malignant tumor.

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Differential diagnostics

Differential diagnostics of periostitis is used to establish an accurate diagnosis when there are symptoms of several similar diseases.

In acute and purulent periostitis, it is necessary to distinguish it from acute periodontitis, osteomyelitis, abscesses and phlegmons, which were caused by other reasons, purulent diseases of the lymph nodes - lymphadenitis, purulent diseases of the salivary glands, and so on.

In chronic, aseptic and specific periostitis, an X-ray examination is performed. In this case, it is necessary to identify thickenings and growths on the bone, necrotic changes and new formations of bone tissue, which were the consequences of periostitis.

Differential diagnostics of chronic periostitis is carried out simultaneously with the detection of osteomyelitis and malignant tumors using X-ray examination. At the peak of the disease, X-ray examination has very good validity. As the inflammatory process subsides and moves into a sluggish stage, the layers on the bone begin to thicken and acquire less pronounced layering. The lesions in the bone also thicken, making it more difficult to diagnose the presence of chronic periostitis.

If an X-ray examination reveals difficulties in making a diagnosis, then a biopsy is used.

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Treatment of periostitis

Treatment of periostitis involves timely detection of the symptoms of the disease, as well as taking the following measures.

In the initial stage of traumatic periostitis, the most effective measure is rest. Ice compresses, physiotherapy - UHF, electrophoresis, ozokerite applications, ultraviolet radiation are used. Antibiotics are prescribed only if there is a suspicion of infection of the lesion.

Aseptic periostitis is treated using physiotherapy. First of all, permanent magnet applications are used, which reduces the amount of exudate. And at the second stage, laser therapy or STP is used to dissolve thickenings and restore the structure of the periosteum.

In case of purulent periostitis, that is, caused by infection, an operation is indicated, during which the periosteum is dissected and the pus is extracted.

The acute form of periostitis requires not only the use of surgery in the form of an operation, but also the prescription of antibiotics, drugs that relieve intoxication of the body, general strengthening medications and physiotherapy procedures.

In chronic periostitis, a course of general strengthening medications and antibiotics is prescribed. In the treatment of this form of the disease, physiotherapy is indicated, which promotes the resorption of pathological thickenings and growths on the bone - paraffin therapy, laser therapy, iontophoresis using five percent potassium iodide.

Prevention of periostitis

Prevention of periostitis consists of timely treatment of the causes that can lead to the development of the disease.

For example, periostitis of a tooth or jaw can be prevented with timely treatment of dental caries, pulpitis and periodontitis. To do this, you need to visit the dentist for preventive purposes once every three months. And if symptoms of dental disease are detected, immediately begin their treatment.

Aseptic periostitis, which was caused by other diseases - tuberculosis, syphilis, osteomyelitis, etc., can be prevented by timely treatment of the underlying disease. It is necessary to undergo timely courses of drug treatment and physiotherapy. And also periodically undergo diagnostics, which can detect the appearance of periostitis at the earliest stage.

Traumatic and post-traumatic periostitis can be prevented by immediately starting treatment of damage to the periosteum tissues - physiotherapeutic and medicinal procedures as prescribed by a doctor. In this case, timely treatment of the injury is the main method of preventing periostitis.

In chronic periostitis, which proceeds unnoticed, without pronounced symptoms, it is necessary, first of all, to eliminate chronic inflammatory processes. These may be inflammatory diseases of various internal organs and systems, which must be subjected to timely therapy.

Periostitis prognosis

The prognosis for recovery from periostitis depends on the form and type of the disease, as well as the timeliness of treatment.

Favorable prognosis concerns traumatic and acute periostitis. If treatment is provided in a timely manner, the patient's condition improves, and subsequently complete recovery occurs.

In advanced cases of purulent periostitis, if treatment was not provided in a timely manner, an unfavorable prognosis for the course of the disease can be predicted. In this case, complications occur - inflammatory processes of all bone tissues appear and sepsis occurs.

Specific periostitis caused by various diseases is chronic. The prognosis for recovery from chronic specific periostitis depends on the success of the treatment of the underlying disease.

Periostitis is a rather insidious disease, leading to serious consequences for the patient's body and skeletal system. Therefore, you should not delay the treatment of periostitis even with a minimal probability of periosteal inflammation.