What is inflammation of the periosteum?

Inflammation of the periosteum (periostitis) is an infection or injury that affects the connective tissue membrane that surrounds your bones. Although the periosteum lies outside your bone, it’s considered part of your skeletal system.

The periosteum is made up of dense irregular connective tissue, with an outer layer of fibrous tissue and inner layers of bone cells called osteoblasts. These bone cells produce new bone when the body needs more skeletal mass. In healthy people, the periosteum also contains a network of blood vessels that provide nutrients to your bones.

periosteum inflammation
periosteum inflammation

Inflammation of the periosteum occurs when these blood vessels become blocked or injured. They may narrow or completely close off. This prevents oxygen and nutrients from getting to your bones. Without them, the periosteum swells, causing pain and other symptoms in nearby muscles. 

The swelling may compress nerves that pass your affected bones. As its name suggests, inflammation of the periosteum has two main causes:  An infection in different parts of your body, such as pneumonia or appendicitis, can cause inflammation of the periosteum in nearby areas. You may get inflammatory osteoarthritis when damage to another joint makes your immune system mistakenly attack healthy tissues around a joint.

Periostitis is an inflammation of the periosteum. This covers all bones in your body except for the bones of the inner ear (which are called otic). The periosteum contains many blood vessels which carry nutrients to the bone, and also nerves that send signals about sensation to the brain.

What causes Periostitis?

Periostitis can be caused by either infection or injury. Periostitis due to an injury typically occurs when there is a fracture in another part of the body, such as with a rib fracture near the spine. Other causes include infections, vasculitis (inflammation of veins), gout, osteomyelitis (infection inside the bone), and compression from a tumor or aneurysm. In some cases, the cause is unknown.

Periostitis may occur with other infections such as appendicitis and pneumonia. When periostitis occurs with these types of infections, it’s usually due to the spread of bacteria from the infection into nearby tissues that include bone or periosteum. You may get inflammation of the periosteum if you have a severe injury that damages tissue around your bones. This can also happen when there’s pressure on nerves near your skin.

Risk factors

A risk factor for periostitis includes: 

  • Any injury that breaks the skin and allows bacteria to infect the tissues underneath it. The most common types of fracture involved include rib fractures from trauma such as a car accident or sports injuries. Limb fractures often break through the ankle, knee, or hip joints. In other cases, athletes who play high-impact sports including football players have been known to develop stress fractures due to overuse. These types of injuries tend to damage the periosteum, a collagen structure that covers bones. 

  • Diabetes mellitus is a condition in which the body doesn't produce insulin or enough insulin for proper sugar metabolism. This can lead to high blood sugar levels that can increase your risk for infections by weakening your immune system. People with diabetes are more likely to get health conditions such as osteomyelitis and septic arthritis because their bodies have trouble fighting off bacterial infections. In some cases, people with diabetic neuropathy get nerve damage in their hands and feet. This can make it difficult to feel when you're hurt, increasing your risk for injury. 

  • Uncontrolled weight gain or obesity puts excess pressure on bones that can damage your periosteum. 

  • Bone tumors are also a cause of periostitis. They often come about as a result of cancer or other conditions caused by abnormal cell growth. 


Symptoms of periostitis include: 

  • Pain, swelling, and stiffness in one area where there's pressure on the affected bones 

  • Fever that comes and goes over several days or weeks 

  • Warmth or redness around the infected area being careful not to confuse this with normal venous congestion that can resemble warmth after walking around for a few minutes. This effect occurs when muscles become contracted. It will go away after you apply heat and massage the muscle through compression which relaxes it allowing blood flow to return normally.

  • Loss of movement in the affected limb 

  • Difficulty walking, due to pain 

  • Sometimes, people notice cracks or chips in their bones that can lead to bone death if left untreated.

Diagnosis of Periostitis

Periostitis is diagnosed by a physical exam and blood tests that check for an infection. An x-ray, MRI scan, or CT scan may be necessary to find out whether periostitis has led to damage in the bone.

X-ray of infected bones shows signs of opacity around the edges where soft tissues are damaged. Bone marrow is not visible through dark areas, whereas it is usually seen on x-rays in healthy bones. More advanced imaging techniques can help doctors see what part of the bone is inflamed. Periostitis can be difficult to diagnose since symptoms are similar to other diseases, including osteomyelitis. This means you might have more than one disease at once if your doctor isn’t familiar with periostitis.

Treatment for Periostitis

Periostitis is usually treated with antibiotics, which are injected directly into your bloodstream. In severe cases, surgery might be necessary to remove dead bone and tissue. This treatment isn’t always needed or recommended because it can cause other complications including bleeding and infection. Your doctor will decide on a treatment plan based on the location of the periosteum in your body, whether there's an infection, and the severity of symptoms you're experiencing. The following treatments can also help: 

  • Decreasing movement in an area near the affected bone 

  • Ice packs and pain medications (such as ibuprofen

  • Splints applied to your body for support 

  • Braces or casts applied to bones that are affected by periostitis 

  • Surgery, which is only recommended for severe cases

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The prognosis of Periostitis depends on whether the condition was caused by an injury or an infection. If it’s due to an infection, the prognosis is good if you are diagnosed early and treated with antibiotics. While another bout of periostitis can occur, this usually isn’t as dangerous as the first episode. Recovery time after diagnosis will depend on how long it took for you to be diagnosed. You may need to take antibiotics for several days or weeks before feeling better. Your doctor might also prescribe pain medications if necessary.

Symptoms may be relieved, but it can take several weeks for the periosteum to heal. This is because the tissue heals slower on some parts of your body than on others. For example, your legs and arms recover faster than the areas surrounding them like your hips and shoulders. If left untreated, you will not get better from periostitis. You may require surgery if the affected bone has died, or if there's a fracture in an area near where periostitis occurred.


Other complications that can arise include: 

  • Numbness, weakness, or paralysis 

  • Bone death (osteonecrosis) 

  • Loss of blood flow to an area around the affected bones (vascular insufficiency) 

  • Bone fractures in the affected area

  • Rarely, people with untreated periostitis can get infections of the heart or brain. This is possible if your infection travels through your blood to another part of your body. Your doctor might detect this by doing routine blood tests while you are being treated for periostitis. If bone tissue dies, it creates an opening in the skull called a cranial fracture. As with other types of hip fracture, this complication can be life-threatening and requires immediate medical attention.

  • Osteomyelitis (infection in the bones) 

  • Blood clots that block blood flow to some areas of your body (embolism) 

  • Damage to surrounding muscles, tendons, or ligaments 

  • Infection of the lining of your heart (endocarditis) 

  • Kidney failure is caused by an infection in your kidneys called pyelonephritis 

People who have diabetes are more likely to get infections due to weakened immune systems. The periosteum is also vulnerable to injuries when people have osteoporosis. This condition causes bones to become thin and brittle due to low bone density. You can help prevent periostitis by avoiding falls that result in fractures. Your doctor may recommend taking calcium supplements if you have osteoporosis. The periosteum is still at risk for injury even if you're careful about falling and fracturing bones. 

What is the difference between osteomyelitis and periostitis?

The main difference between osteomyelitis and periostitis is that osteomyelitis is an infection of the bone marrow or bone, while periostitis involves inflammation of the periosteum.

Osteomyelitis is when there's an infection in either the bone marrow or actual bone itself. This can happen when there's a break in the skin that gets infected with bacteria then spreads to surrounding tissues including muscle tissue. It can also spread to your bloodstream through your veins causing further infections called septicemia. Osteomyelitis tends to cause symptoms such as swelling, pain, and warmth in the area where the bacteria is found. Other symptoms include:

  • Fever

  • Chills

  • Weakness or fatigue

  • Loss of appetite and weight loss.


Prevention includes:

  • Taking preventive measures to avoid fractures, such as wearing protective gear for sports and participating in activities where you're less likely to fall and injure yourself. 

  • Eating a healthy diet that's rich in nutrients such as calcium ensures you have strong bones, which can help prevent osteoporosis.  

  • Having regular bone density tests to check if your bones are brittle and another type of fracture might occur due to weakened bones.

How long does periostitis last?

Periostitis usually subsides within a few weeks or months depending on the initial cause. In cases of osteomyelitis, antibiotics can treat the infection that caused it. However, if treatment does not include surgery, your doctor may need to remove dead tissue surrounding bones. The best way to prevent periostitis is to avoid falls and fractures.  

What does periosteal mean?

The periosteum is the membrane or sheath that covers your bones. The periosteum contains blood vessels and nerve endings, which help your bone growth. The periosteum also houses muscle tissue and provides structure to your body.