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What You Should Know About Periostitis

What is periostitis?

Periostitis is a condition that results in inflammation of the band of tissue that surrounds bones known as the periosteum. This condition typically affects people who repetitively jump, run, or lift heavy weights. If you’re an avid runner, you may be familiar with shin splints, which are a type of periostitis.

Repetitive stress on the tibia, or shinbone, causes shin splints. This condition often improves with rest, but it can lead to chronic discomfort and pain.

Periostitis is usually benign and well-tolerated. It can also take other forms, though, including an infectious condition that’s much more serious and may require more intensive therapy.

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Types

What are the types of periostitis?

The two types of periostitis are chronic and acute.

Infection of the bone can lead to acute periostitis, which is a painful condition. This may lead to necrosis, or death of the living tissue surrounding the bone.

Chronic periostitis can result from trauma and stress to the bones. Shin splints from running are an example.

Symptoms

What are the symptoms of periostitis?

Acute periostitis symptoms

The symptoms of acute periostitis can include:

  • intense pain
  • difficulty bearing weight on the affected limb
  • pus formation
  • a fever
  • chills
  • swelling of the tissue surrounding the bone

Chronic periostitis symptoms

Chronic periostitis, or even temporary bouts of shin splints and similar injuries, also causes swelling and inflammation. The bones affected by noninfectious periostitis also ache and may be tender to the touch. People who have chronic periostitis don’t appear as ill as those who have acute periostitis.

While periostitis often affects the legs in your bones, it can also affect the long bones in the arms and the spine.

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Causes

What are the causes of periostitis?

The causes of periostitis vary depending on whether the condition is acute or chronic.

Causes of acute periostitis

Acute periostitis can develop from a variety of infections in other parts of the body. For example, a urinary tract infection or a sexually transmitted disease, such as syphilis, could lead to periostitis. The same is true for a cut that doesn’t heal and gets deeper, eventually reaching the bone.

People who have chronic ulcers, such as people with diabetes or people who are immobile and develop pressure sores, are more likely to develop periostitis. This is especially the case if the ulceration doesn’t heal or is allowed to continue to develop. Certain autoimmune diseases can lead to acute periostitis. Leukemia and various cancers and blood disorders are all potential conditions that can lead to serious bone infections.

Proliferative periostitis, or osteomyelitis, is one type of bone infection. Staphylococcus or and other similar bacteria is usually the cause. Staphylococcus bacteria are present in healthy people. They’re considered a part of the normal bacteria that reside on the skin and the nose. This type of bacteria may also cause infections of the skin, especially in people who have weakened immune systems or chronic underlying illnesses. If you don’t get treatment for an infection due to Staphylococcus or related bacteria, you may get osteomyelitis. Osteomyelitis is an infection of the bone itself.

Causes of chronic periostitis

Repeated stress on your bones can lead to chronic periostitis. Athletes and people who frequently jump, turn, or lift weights are at an increased risk of developing shin splints. The repetitive stress that these activities places on your bones can lead to the inflammatory changes that are responsible for periostitis.

Risk factors

What are the risk factors for periostitis?

Risk factors for acute periostitis

Having any of the following increases your risk of acute periostitis:

  • any systemic infection, especially bloodstream infections
  • joint replacement surgery or another type of orthopedic surgery
  • poor circulation, which can be due to atherosclerosis, diabetes, or pressure sores or ulcers
  • an open fracture, which is a fracture of the bone that pierces the skin and exposes the bone to the germs of the skin and surrounding environment

Risk factors for chronic periostitis

Exercise

Athletes, such as runners, dancers, and soldiers are at increased risk of chronic periostitis. Anyone who dramatically increases their exercise regimen is at risk for developing periostitis.

Osgood-Schlatter disease

Certain other noninfectious forms of periostitis, such as Osgood-Schlatter disease, are more common in growing children. Osgood-Schlatter is an inflammation of the knee, where the tendon from the knee attaches to the tibia. This condition results in a chronic pain and swelling of the proximal shin, or the area just below the kneecap, or patella.

Osgood-Schlatter disease is most common in adolescent boys, especially those who are physically active and perform higher risk activities such as jumping and running.

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Diagnosis

How is periostitis diagnosed?

See your doctor if running or other activities lead to shin splint symptoms and rest doesn’t help. You should see your doctor if you have pain in your joints or your bones that lingers. Tiny fractures may be present. In the case of acute periostitis, a serious infection could be damaging your bones.

During your appointment, your doctor will examine the affected area. They may apply some pressure to the area to help diagnose the problem, so be prepared for a little discomfort. Tests they may order include:

  • an X-ray, which may reveal fractures or signs of damage due to infection
  • an MRI scan, which can provide a detailed look at the bone and the surrounding soft tissue
  • bone scans to determine if an infection is present
  • a complete blood count to determine your white blood cell count and look for evidence of infection
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Treatment

How is periostitis treated?

Your treatment options depend on the type of periostitis you have.

Treatment for acute periostitis

Doctors use antibiotics to treat the underlying infection of acute periostitis. If the infection becomes suppurative, or produces pus and fluid, your doctor may need to drain it surgically.

Your doctor may also have to remove any bone tissue that becomes necrotic from infection. Doing this can prevent the spread of infection. This is called surgical debridement.

Treatment for chronic periostitis

For shin splints and similar stress-related injuries, try rest and ice. Take a break from high-impact activities, such as running or jumping, and go with more low-impact exercises, such as biking or swimming. Applying ice can bring down swelling and reduce inflammation. Taking an anti-inflammatory medication such as ibuprofen (Advil) may also help.

If home remedies don’t work, you may have a more serious underlying injury that requires physical therapy. You may need a steroid injection to reduce inflammation in your knee or other joint. In general, though, resting the affected area should ease symptoms.

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Outlook

What is the outlook for people with periostitis?

If you have surgery to treat acute periostitis, you’ll probably get antibiotics intravenously, or through your veins, for four to six weeks. A few weeks of oral antibiotic treatment may follow. After that, your recovery will depend on the nature of the bone surgery.

If you had surgery on a bone in your leg, you might need several weeks of physical therapy to regain normal walking ability. If you had surgery on a bone in your arm, you might need to limit the use of that arm for several weeks.

For a minor case of shin splints, a few days of rest and ice may be enough to ease the inflammation. Periostitis can develop when minor injuries aren’t allowed to heal properly. The more time you give the little injuries to heal, the more likely you are to avoid a major problem later.

Acute periostitis is rare if you haven’t had bone surgery or if you don’t have major infections or circulation problems.

Prevention

How can you prevent periostitis?

Preventing chronic periostitis is often a matter of avoiding overuse injuries. If you run frequently, work with a trainer or coach to make sure your form is correct. The same is true for dancers and other athletes.

If you enjoy activities that place you at risk for periostitis, you should pay attention to pain signals. Stop exercising if you feel anything unusual, especially in your joints or in the long bones of your arms and legs.

The most important step in preventing acute periostitis is to control any conditions that increase your risk of developing this disease. This includes:

  • controlling your blood sugar if you have diabetes
  • quitting smoking if you regularly use tobacco
  • losing weight
  • making dietary changes to control blood pressure and cholesterol levels

If your doctor has told you that you’re at an increased risk of infection, take precautions to avoid cuts, scrapes, and exposure to people who have infectious diseases. You may have a higher risk for infection is you have a condition that has weakened your immune system

Pain in your legs, back, or arms may be due to a serious but treatable condition. Don’t ignore the pain. See your doctor and follow their advice. Periostitis isn’t always preventable, but you can reduce your risk.

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