Question
What are the key components of an evaluation for suspected osteomyelitis in the shoulder?
Answer
Evaluating a patient with suspected osteomyelitis of the shoulder requires a systematic approach that includes medical history, clinical assessment, and advanced imaging techniques. A thorough patient history should focus on risk factors such as recent infections, intravenous drug use, diabetes, immunosuppression, or prior surgical interventions. A history of persistent, unrelenting pain that does not fluctuate with movement is a key distinguishing feature of osteomyelitis. Additionally, clinicians should assess for systemic signs such as fever, malaise, and night sweats.
A physical examination should include palpation of the affected area to assess for tenderness, swelling, and warmth. Passive range of motion testing can differentiate osteomyelitis from musculoskeletal conditions; significant pain during passive movement suggests articular or bony involvement rather than soft tissue dysfunction. Blood tests, including complete blood count (CBC), ESR, and CRP, serve as important indicators of systemic infection. In cases where osteomyelitis is suspected, MRI is the gold standard for early detection, as it can reveal bone marrow edema, abscess formation, and cortical destruction before plain radiographs show abnormalities. Timely evaluation and accurate diagnosis are essential to prevent the progression of infection and avoid long-term functional impairments.
This Ask the Expert is an edited excerpt from the course, "Comprehensive Management of Shoulder Pain Secondary to Osteomyelitis," presented by Rina Pandya, PT, DPT, FHEA, PGLTHE.
