Periosteal reaction

A periosteal reaction is the formation of new bone in response to injury or other stimuli of the periosteum surrounding the bone. It is most often identified on X-ray films of the bones.

Etiology

A periosteal reaction can result from a large number of causes, including injury and chronic irritation due to a medical condition such as hypertrophic osteopathy, bone healing in response to fracture, chronic stress injuries, subperiosteal hematomas, osteomyelitis, and cancer of the bone. It may occur as part of thyroid acropachy, a severe sign of the autoimmune thyroid disorder Grave's disease.

Diagnosis

The morphological appearance can be helpful in determining the cause of a periosteal reaction (for example, if other features of periostitis are present), but is usually not enough to be definitive. Diagnosis can be helped by establishing if bone formation is localized to a specific point or generalized to a broad area. The appearance of the adjacent bone will give clues as to which of these is the most likely cause.

References

(1994). Diagnosis of Bone and Joint Disorders. 3rd ed, Philadelphia: W.B. Saunders.
Ved N, Haller JO (2002). "Periosteal reaction with normal-appearing underlying bone: a child abuse mimicker". Emerg Radiol 9 (5): 278–82.
Marmur R, Kagen L (2002). "Cancer-associated neuromusculoskeletal syndromes. Recognizing the rheumatic-neoplastic connection". Postgrad Med 111 (4): 95–8, 101–2.
Viola IC, Joffe S, Brent LH (2000). "Primary hypertrophic osteoarthropathy". J. Rheumatol. 27 (6): 1562–3.
Burstein HJ, Janicek MJ, Skarin AT (1997). "Hypertrophic osteoarthropathy". J. Clin. Oncol. 15 (7): 2759–60.