Periosteitis, or periostitis, affects the periosteum covering the bone. The condition, caused by a variety of causes, is completely curable in most cases with proper treatment.
What is periosteitis?
Osteomyelitis describes an inflammatory change in a person’s periosteum. In specialized medicine, the condition is therefore also referred to as periostitis. In most cases, periostitis is accompanied by thickening and water retention in the area of the affected periosteum. Periostitis often occurs in areas of a bone where tendons and/or muscles are attached. A distinction is made, for example, between acute and chronic forms of periostitis; in medicine, periostitis is referred to as chronic if the disease is present for a long time. In most cases, periostitis is considered chronic when the symptoms have been present for at least 3 months. Periostitis can be very painful and occurs comparatively frequently in athletes – periosteitis is often localized here on the tibia.
Causes
Periosteitis can be caused by both mechanical and bacterial causes. Mechanical causes that may be behind periostitis include, for example, prolonged overloading of the bone. Particularly in athletes, mechanical factors such as overtired muscles, wearing unsuitable footwear, foot malpositions or blows or kicks during contact sports can also promote periostitis. If periostitis is bacterial, it usually develops as part of an infection with staphylococci (spherical bacteria) or streptococci (spherical to egg-shaped bacteria). Infection with various viruses can also lead to the development of periostitis. Such pathogens enter the body, for example, in the course of surgery or open injuries. If a person already has infectious underlying diseases, pathogens can enter the bloodstream from here and lead to periostitis elsewhere.
Symptoms, complaints, and signs
Periostitis can lead to a variety of health problems and, in isolated cases, can cause serious complications. Regardless of where the periosteitis occurs, severe, usually throbbing pain develops as the disease progresses. This pain is most noticeable during movement or when pressure is applied to the affected area. A characteristic feature of the pain is that it occurs predominantly during physical movement and subsides rapidly during periods of rest. The affected area may be reddened and overheated, and swelling may also occur. In addition, movement restrictions are possible. Purulent periostitis may cause accompanying symptoms such as malaise and fever. In this form, the pain can be very severe. A purulent discharge often occurs in the area of inflammation or a soft tissue fistula develops that may ooze and cause itching. The symptoms of periosteum inflammation usually appear quite suddenly. Due to the pain, sleep disturbances and depressive moods then occur, which are accompanied by a further decrease in well-being. In individual cases, edema forms, from which infections and skin changes can develop. If periostitis is treated early, the symptoms soon subside. If left untreated, complications such as permanent movement disorders or chronic pain may develop.
Diagnosis and course
A patient interview can give the treating physician initial clues about the causes of possible periosteitis. To diagnose periostitis, corresponding areas of the body are then usually examined for typical symptoms, such as water retention or thickening. Frequently, palpation of the part of the body affected by symptoms by the attending physician also helps to confirm the diagnosis of periostitis. X-rays, among other things, can be used to determine whether periostitis is already chronic. In contrast to acute periostitis, periostitis with a chronic course usually develops gradually; the symptoms of chronic periostitis are also initially often milder than those of acute periostitis. With early and expert therapy, acute periostitis in particular can be completely cured in many cases.
Complications
As a result of periostitis, patients experience significant limitations and discomfort in their daily lives. In most cases, patients primarily suffer from relatively severe bone pain in the affected regions. This pain can occur in the form of pain at rest or as pressure pain. Pain at rest can also lead to sleep disturbances and thus to increased irritability on the part of the patient. Likewise, there is usually severe swelling and redness, and further restrictions on the patient’s movements. The extremities are not infrequently warm and there is a general tiredness and fatigue. The patient’s ability to cope with stress also decreases significantly as a result of the periosteum inflammation. Water retention may also occur in the affected areas. As a rule, periostitis can be treated well if it is detected early. There are no particular complications. Treatment is carried out with the help of therapies and medications and in most cases leads to a positive course of the disease. The life expectancy of the affected person is also not affected by periosteum inflammation. In some cases, periostitis can also lead to inflammation of the bone marrow.
When should you see a doctor?
Osteomyelitis is a disease or a complaint that does not require an immediate visit to the doctor. This is because the inflammation usually results from overuse and, if the cause of the stress is removed, it heals spontaneously in most cases. Before consulting a doctor, it therefore makes sense to first research the cause and eliminate it (for example, overstraining during sports or wearing unfavorable footwear). If the symptoms improve in relation to the omission of the cause, the visit to the doctor is not necessary. This is basically true even if irritation is again accepted by allowing the trigger to occur again. The periosteum inflammation is also well amenable to self-treatment. However, if the symptoms do not improve with immobilization and other measures such as cooling, the doctor should be consulted. This also applies to cases in which no connection with a triggering behavior can be established even with the closest observation of the symptoms and their occurrence. Here it makes sense to consult the doctor to clarify whether there is not another explanation for the painful reaction at the front edge of the shins. A visit to the doctor is also advisable in case of unilateral discomfort that does not subside, as well as in case of severe symptoms.
Treatment and therapy
The therapy of periosteitis depends initially on the individual cause of the disease. Periostitis, which is based on an overload of the affected bone, often manifests itself on the shin or forearm; medical measures frequently used here include cooling and subsequent immobilization of the affected body part. Such immobilization is possible, for example, by applying a tape bandage (a bandage using adhesive plaster tape, which is frequently used in sports medicine in particular). Another therapeutic component for periostitis caused by overuse is often the administration of so-called anti-inflammatory drugs – these are drugs with an anti-inflammatory effect. Periostitis caused by bacteria is often treated with antibiotic drugs. Occasionally, bacterial periostitis may be accompanied by osteomyelitis, especially in people with a weakened immune system. Such a combined disease of periostitis and inflammation of the bone marrow is often treated by antibiotic administration with the help of infusions.
Outlook and prognosis
In principle, periosteitis is curable. It can be very protracted. The success of therapy and the duration depend on the particular cause, extent and intensity of the disease. Age and the condition of the immune system also play a role in the healing process. If the established therapy plans are followed by the patients, there is a good chance that no permanent damage will remain and mobility will return. If the cause is overuse, 1-2 weeks are to be expected until noticeable relief is achieved in mild cases.After this, the load on the corresponding part of the body should only be increased slowly in order to achieve a lasting improvement. If the necessary rest periods are not observed or the cause of the one-sided load is not eliminated in the case of incipient periostitis, a protracted and severe disease can develop from it. An established therapy plan should be consistently followed by the patient. Otherwise, there is a risk that the inflammation will become chronic. Surgical intervention can then help in this case. After the operation, the affected part of the body must then be rested for several weeks to a month. In the case of a bacterial infection as the cause of the periosteum inflammation, medication can help quickly. If the pain of the affected body part subsides, the patient’s general physical condition must be assessed before resuming weight-bearing.
Prevention
There is limited prevention of periostitis caused by pathogens; however, the risk of disease can be reduced by strengthening the body’s immune system. In sports, for example, avoiding overly intense exercise can prevent periostitis. Wearing the necessary protective clothing and appropriate footwear can also help prevent periostitis.
Aftercare
Periostitis is associated with a severe impairment of the immune system. For this reason, and because of the severe pain associated with the disease, physical rest is of utmost importance even after successful completion of therapy. Aftercare initially consists of reducing the usual physical activities for some time. This applies in particular to those sports or movements that led to the periosteum inflammation. If the disease was caused by bacteria, physical rest also applies as part of the aftercare. Athletes are strongly advised to maintain a moderate level of physical exertion for several months after the end of the periostitis, so as not to provoke a new outbreak of the disease. This is because in the absence of follow-up care and too rapid a return to usual exercise habits, it is possible for periostitis to reoccur even though it appeared to have completely resolved after therapy. Follow-up with a health and fitness consultant is therefore beneficial after periostitis. Follow-up care may also involve patients giving up certain sports completely. In any case, it is necessary for sufferers to attend regular medical checkups at least one to two years after periosteumitis to have the condition of the periosteum assessed and to make statements about the levels of inflammation in the blood.
What you can do yourself
With periosteum inflammation, patients experience extremely intense bone pain that significantly limits their daily life. Painful symptoms occur both when performing movements and when the affected person is resting. Taking painkillers provides relief here, so that the overall well-being improves. The extremities are poorly supplied with blood, causing the patient to feel cold and often tired and groggy. Decreased resilience and a reduced ability to concentrate are not uncommon. Severe swelling and redness have a negative effect on well-being, and water retention in the corresponding areas worsens the state of health. The affected person needs a lot of rest as well as medication and ointments to avoid a more severe course of the disease. Often, depressive moods and anxiety further limit the quality of life. Psychological counseling as well as the exchange with other sufferers provides support and has a beneficial effect on the state of mind. If periostitis is treated early, complications are usually rare. However, the ointments and bandages can trigger allergies. A clarification in advance, which allergy risk is present, can positively influence the choice of ointment and medication. If the periostitis takes a purulent course, the patient feels very unwell. The general condition deteriorates increasingly and there is an immediate need for medical treatment.