Osteomyelitis - Diagnosis

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How is osteomyelitis diagnosed?

The diagnosis of osteomyelitis begins with a complete medical history and physical examination. During the medical history, the doctor may ask questions about recent infections elsewhere in the body, past medical history, medication usage, and family medical history.

The physical examination will look for areas of tenderness, redness, swelling, decreased or painful range of motion, and open sores.

The doctor may then order tests to help diagnose osteomyelitis. Several blood tests can be used to help determine if there is an infection present. These include a complete blood count (CBC), the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and blood cultures. None of these is specific for osteomyelitis but they can suggest that there may be some infection in the body.

Imaging studies may be obtained of the involved bones. These can include plain radiographs (X-rays), bone scans, computed tomography (CT) scans, magnetic resonance imaging (MRIs), and ultrasounds. These imaging studies can help identify changes in the bones that occur with osteomyelitis.

After an area of bone is identified with possible osteomyelitis, a biopsy of the bone may be obtained to help determine precisely which bacteria are involved, and the culture of this can indicate the best choice for antibiotic treatment.

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See what others are saying

Comment from: Nancy S, 55-64 Female (Patient) Published: November 11

I was waiting on the steps for my mother to pick me up from school a few days before my 11th birthday. When I got up to walk to the car, my ankle hurt and so I limped a little. My mother noticed and when it didn't get any better, she took me to my pediatrician a day or two later. He questioned me closely and (thank goodness) believed me when I said I had not injured it in any way, it just started hurting out of the blue. He had me take off my shoes and socks on both feet, which I didn't understand. He placed his palm on the painful, mildly swollen ankle, then on the other one, back and forth. He then told me he was checking me into the hospital that night! Blood tests were done at the hospital and osteomyelitis confirmed. I was put on a penicillin IV, which I was kept on until I developed an allergy; I was switched to something else for the remainder of the four weeks I spent in the hospital. Near the end, he called in a specialist to see if I could be released after four weeks instead of the usual six. They confirmed that my doctor had caught it so quickly that the infection had been successfully treated in the shorter time. He told us that he had remembered reading an article in a medical journal that said osteomyelitis was being underdiagnosed. It looked like a sprain and patients and doctors alike were ignoring or mistaking it, with serious consequences. When he felt each ankle, he had been looking for increased warmth in the swollen ankle, a sign of infection that a sprain wouldn't have. I have always been impressed and grateful. Thank you, doctor.

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Comment from: 123terry, 75 or over Female (Patient) Published: March 11

My bone infection (osteomyelitis) was discovered during a hip replacement surgery. The infection was caused by streptococcus bacteria. Some bone and tissue were removed, and a spacer filled with bone cement and antibiotics were attached at the pelvic bone with 2 screws. The antibiotics did not do the job. Right now I am looking at the same procedure again with a new spacer again. I am not sure about going down this road again.

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