Last updated: November 4, 2014

ICD-9 Code: 730.30.
ICD-10 Code: M90.1

Definition: Periostitis refers to radiographic elevation of the periosteum in response to injury, inflammation, or infection.

Pathology: Periostitis is often associated with increased vascularity and local blood flow. Early round cell infiltration into the outer or fibrous layer is followed by deposition of new bone on the original cortical bone. Periosteal new bone is less dense pathologically and radiographically.

Associated Disorders: Hypertrophic pulmonary osteoarthropathy (primary or secondary), osteomyelitis, thyroid acropachy, psoriatic arthritis, RA, reactive arthritis, juvenile arthritis, DISH, syphilis, tuberculosis, leukemia, lymphoma, plasma cell dyscrasias, neurofibromatosis, drugs (hypervitaminosis A, fluorosis, prostaglandin E, IL-11), or venous stasis may be associated.

Cardinal Findings: Periostitis may be asymptomatic or painful. It tends to be painful during the early or acute stage. Pain may be described as deep, aching, or burning. There may be palpable tenderness, local warmth or swelling, with or without associated pitting edema.

Diagnostic Tests: Characteristic changes include less dense, new bone formation that is elevated, running parallel to cortical bone and may appear linear, layered, or spiculated.

Imaging: Periostitis is best imaged by conventional radiography but may be identified by scintigraphy or CT. Periosteal elevation is frequently found near (in decreasing frequency) the diaphysis, metaphysis, or epiphysis of long bones, especially the tibia, fibula, radius, metacarpals, or metatarsals.

Therapy: Treat the underlying disorder. Limb elevation, local ice, or NSAIDs may be effective in managing pain.

Resnick D, Niwayama G. Enostosis, hyperostosis and periostitis. In: Resnick D, Niwayama G, eds. Diagnosis of bone and joint disorders, 2nd ed. Philadelphia: WB Saunders, 1988:4073–4139.

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