A thorough physical and orthopedic examination is important, as other orthopedic diseases (eg, osteochondrosis, hypertrophic osteodystrophy) may be similar to signs of panosteitis and, in some cases, occur concurrently.
Pain on direct palpation of the diaphysis of long bones is characteristic of panosteitis. The ulna is most commonly affected, followed in frequency by the radius and humerus.1 Radiographs should be obtained to confirm diagnosis and rule out other pathologies.
Radiographic signs of panosteitis frequently lag days to weeks behind clinical signs.1,3 The earliest radiographic sign of panosteitis is a decrease in opacity around the nutrient foramen. Later signs include an increase in mineral opacity within the medullary canal of long bones and loss of the normal trabecular bone pattern (Figure 1). Smooth periosteal and endosteal new bone may also be seen in more severe cases (Figure 2). Radiographs of the affected limb may be compared with those of the contralateral limb to assist in diagnosis. Nuclear scintigraphy may assist in diagnosis in cases in which radiographic changes have not yet developed.4
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