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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.

Return to Osteomyelitis

See what others are saying

Comment from: oldlady, 75 or over Female (Patient) Published: January 10

I'm 84 years old and 6 months ago I fell off my bike and skinned my knee. No big deal, I thought. We were on vacation in Colorado and my two granddaughters urged me to go swimming with them in a public pool about 3 days after the accident. I looked at my wound and it seemed to be scabbed over so I went. The next day my knee swelled up and I couldn't bend it. We got home a few days later and I saw my regular doctor and he insisted I go to the hospital immediately as my whole leg was swollen. With the treatment the osteomyelitis seemed to get better and I went home with antibiotics to take. Then it got worse and I went back and started a different antibiotic. Eventually he took a culture and changed the antibiotic once again. I took it for 6 weeks and it was still there so I had a PICC line installed and had that for 6 weeks but my white blood count went down to a dangerous level. Now I am off everything and have no pain or loss of movement but just little sensations in my knee where the infection was. I've just had a blood test and MRI and don't know the results yet but I think I'm cured. Long involved process. Never go in a public pool with a skin wound even if it looks okay!

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Comment from: KBehr, 65-74 Male (Patient) Published: July 08

I had been in and out of our city hospital because of heart problems. On each occasion, I suffered more and more pain in my lower back and hips. The doctor asked me about my back and I told him I had suffered with back problems for 25 years. Well, he said maybe it was this bed and they will get me an extension. I had been taking 10 mg methadone 3 a day for several years and always found it to be a terrific pain medicine. The hospital pain doctor visited and told me I was on too much medication. The fourth admission happened with a 104.5 temperature, heavy vomiting and delirium. The hospitalist called in the infection doctor who, after 1 day, concluded I had osteomyelitis and discitis and I have been on antibiotics and not quite enough pain medicine since that time. In fact, 4 days after discharge, I was back in the hospital specifically to somehow moderate the pain; a 10 day process! I have been told by other doctor friends (I am a psychologist who works in the medical arena), and everyone, but the treating doctor thinks that since it seems the pain from the infection began 6 months before diagnosis, and since the E-coli has settled deeply into my spine, I could be in for a lifetime of related problems. And on it goes.

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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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