Periostitis

Periostitis - Shin splints, acute or chronic. Periostitis is specific (tuberculosis and syphilis) and non-specific (simple and purulent).
Simple periostitis develops when injuries and fractures of the bones and the presence of inflammatory focus near periosteum. Symptoms: pain, restricted swelling bone formation is possible calcification and osteophytes (see), defined radiographically.
Treatment: first, rest, ice, then heat treatments and physiotherapy.
Simple fibrous periostitis characterized callused thickening of periosteum with her long irritation. Treatment is the removal of stimulus.
Purulent abscess is caused by infection penetration from neighboring purulent or injury periosteum. At purulent abscess periosteum exfoliate with pus and formed subperiostalr (subperiosteal) abscess that can lead to the osteomyelitis (see). Symptoms: acute onset, fever, sharp pain, swelling and education ulcer, leukocytosis. Treatment: first, antibiotics, when the Constitution of the ulcer is its opening.
Chronically flowing periostitis can cause an accumulation under the periosteum sero-mucous fluid (albuminuria periostitis). Chronic irritation of the periosteum appears excessive growth of the bones (references for additional information periostitis). The resulting osteophytes sometimes cause pain; require surgical treatment.
Tubercular abscess develops more often in the transition process to the periosteum of the nearest tuberculous lesion (see Tuberculosis of bones and joints).
Syphilis periostitis often occurs in the tertiary period of syphilis, is affected area divisov tibial bone, the process is accompanied by a significant, often symmetrical thickening bones as determined by x-ray. Symptoms: pain, worsening at night, dense, elastic swelling spindle-shaped or round shape without changing the skin over it, rarely the collapse of gum, a breakthrough her and ulceration. The specific treatment (see Syphilis).

Periostitis (periostitis; from the Greek. peri - around, around and osteon - bone) - Shin splints.
The inflammatory process in the periosteum rarely occurs primarily (more often when it is wound), in most cases it develops secondarily as a result of inflammation of the bone (osteomyelitis, bone wound suppuration, etc.,) or the surrounding soft tissues (when the abscess etc), and also due to the impact of microorganisms in sepsis hematogenous route. Amazed may periosteum both flat and tubular bones.
Pathological anatomy. Given the nature of morphological changes allocate plain, purulent, albuminuria, fibrous, references for additional information, as well as tuberculosis and syphilis P.
Simple periostitis characterized by redness, swelling and infiltration of periosteum segmented by leukocytes. When purulent inflammation, in addition, is formed free purulent exudate, which, accumulating subperiosteal, leads to the formation subperiostalr ulcer and may cause detachment of the periosteum from the bone. When albuminates., in the periosteum accumulates jelly or mucous exudate with the formation of cavities, surrounded by granulations and then fibrous capsule. Assume that at the heart of this process is the influence of microorganisms attenuated or that this form of Peterhof is the outcome of purulent P. or associated with tuberculosis infection.
When any form of periostitis process, beginning in the periosteum in the future may spread to the bone, resulting in the combined lesions of the type of osteoporotic (smasteril), sometimes with the sequestration of surface departments or the entire thickness of compact discs.
The inflammatory process in the periosteum could end without a trace or after it is fibrous thickening of the periosteum (the fibrous P. often with the formation of complexes beams bone (P. references for additional information, Fig. 1 and 2). Both that, and another is the result of reactive growth of the tissues of the periosteum in response to irritation caused by the rebuilding process and essentially inflammation is not. A similar process occurs by tumors, bone injury, etc.,
The tubercular abscess process usually apply to the periosteum with the bone and is manifested by the growth of specific granulation, often with caseous necrosis.
Syphilis P. can say that the formation of gum, in the form of specific productive inflammation, leading to fibrosis and of ossification of the periosteum.


The clinical picture. The clinical course there are acute (subacute and chronic periostitis. In most cases, the inflammatory process starts in the innermost layer of the periosteum.
Simple abscess (periostitis simplex) usually develops after various injuries (of traumatic P.), as well as in circumference inflammatory lesions (reactive P.). Clinically P. accompanied by pain in limited area and sometimes the swelling. Treatment first anti-inflammatory (cold, rest)is recommended heat. In severe pain and protracted process appropriate physiotherapy (iontophoresis with novocaine, diathermy, etc.).
Purulent abscess (periostitis purulenta) - a common form of P. Inflammatory process can progress to the surrounding soft tissues (cellulitis) and the substance bones; breakthrough pus through the skin leads to the formation of a fistula. When metastatic P. usually attacked periosteum of the long bones. Clinical course: acute onset typically with increasing temperature to 38-39 degrees and a notable increase in the number of leukocytes; at the beginning of the disease frequent chills. Considerable pains are in the lesion; palpation painful swelling, often fluctuation. With the rapid spread within the soft tissue can develop pyosepticemia. Treatment - in the initial stages of the process remove the pus punctures and introduction of antibiotics. The lack of effectiveness of this treatment is the opening of the suppurative focus.
Albuminuria periostitis (periostitis albuminosa) is localized usually ends of divisov long bones (mostly hip); usually ill at a young age (15-20 years), mostly men. Almost always after injury appears painful swelling, sometimes substantially. The temperature rises, but soon comes to normal. Swelling in the beginning dense, may gradually soften and fluctuate. The greatest difficulties can cause differentiation sarcoma. Necessary to solve the issue on the basis of x-ray examinations and diagnostic puncture (if albuminates P. punctat is usually transparent viscous liquid, pale yellow, with a malignant tumor - cell neoplasms).
Treatment - in some cases it is possible to limit suction of fluid; often requires opening cavity and remove the affected tissue; it is sometimes possible to remove racemose education along with the shell.
Fibrous abscess (periostitis fibrosa). Calloused fibrous thickening of the periosteum, usually densely spanne with the bone that develops under the influence of chronic prolonged irritation. Can be observed on the tibia in cases of chronic leg ulcers, chronic inflammation of the joints and so on Treatment is the removal of stimulus.
References for additional information periostitis (periostitis ossificans) - a common form of chronic abscess that develops during prolonged irritation and characterized by the formation of new bone. In many cases, the process is developing in a limited area; there is a separate warty or needle elevation - osteophytes. Diffuse development of osteophytes can lead to the total thickness of the bones (giperostos). Phenomena references for additional information generalized P. underpin the so-called diseases of Bamberger - Marie (see Marie - Bamberger syndrome).
In the diagnosis of periostitis role played by x-ray examination. Upon termination of irritation further development of the disease stopped. Sometimes Sinology, for example between the bodies of two adjacent vertebrae between the tibia bones. The treatment effect on the basic process. When osteophytes considerable size, causing pain or impaired function, you need to remove them.
Tubercular abscess (periostitis tuberculosa) occurs most often in the ribs and bones of the face. The course of chronic, often with the formation of fistulas, pus, and so on Treatment by the usual rules of treatment of tuberculosis of bones.
Syphilis periostitis (periostitis luetica) can develop as in congenital and acquired syphilis. In congenital syphilis is usually observed the symmetrical arrangement of multiple foci P. references for additional information, particularly on the tibia, iliac and long tubular bones of the upper extremities. With acquired syphilis lesions P. may appear in the secondary period, but the greatest intensity and prevalence of reach in the tertiary period; often ossification combined with gummosis process.
When gummesson P. develop a flat elastic thickening, more or less painful. Seen as isolated gum, and diffuse gummosa infiltration. Gum develop most often in the bones of the skull cap, sternum, tibia, the clavicle. The specific treatment.
At the break gum out with the formation of ulcers and have bone lesions recommended surgical treatment according to General rules.
Periostitis observed also at rheumatism, gonorrhea, leukemia, actinomycetes, smallpox, leprosy, after typhoid, and so on, Sometimes periosteal layers can be on the bones of the lower leg (especially tibia) varicose extensions deep veins of the leg.
With Gaucher disease (see Gaucher disease) described a kind of periosteal thickening, mainly around the distal half of the thigh.
There is also P. tibial bone due to the constant high static loads.

Fig. 1. References for additional information periostitis of diaphysis hips in chronic purulent osteomyelitis.
Fig. 2. Tissue growth of periosteum with the formation of bone beams with references for additional information the periostitis.