Infections Presenting as Musculoskeletal Disorders

Musculoskeletal infections in adolescents, although uncommon, represent a unique therapeutic challenge (Table 6). The pathogenesis and prognosis of musculoskeletal infections differs in children and adults due to behavioral differences, bone growth and changing vascularity. For example, in children less than 8 months of age, the metaphysis is traversed by capillaries, allowing spread of infection. In contrast, the growth plate in older children and adolescents is avascular and, together with the thicker bony cortex and more adherent fibrous periosteum, it acts as a barrier to spread of infection (111). Hence, osteomyelitis in adolescents is more likely to spread via purulent debris into the cortical lamellae, and less often into the joint, than in younger children. Once the growth plate closes late in adolescence, hematological osteomyelitis often begins in the diaphysis and can spread to involve the whole intramedullary canal. Adolescents will generally have minimal restriction of movement in the affected extremity, in contrast to the pseudo-paralysis seen in young children with osteomyelitis. Contiguous osteomyelitis, describing bone infections caused by extension of infection from adjacent soft tissues, is most common in adults, but rare in children and adolescents.

Adolescents can exhibit manifestations of infection common to children and adults. The main difference from childhood is the increased frequency of arthritis secondary to sexually transmitted disease. Other entities seen in childhood, but less commonly in adulthood, such as rheumatic fever, remain prevalent in adolescence.

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