Radiographic Musculoskeletal Findings Indicating Opioid Misuse: An Overview for Orthopedic Surgeons
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Given the high prevalence of musculoskeletal conditions in the USA, it is important for orthopedic surgeons to promptly identify patients who may be at risk for opioid misuse.
The aim of this literature review was to elucidate various musculoskeletal pathologies and complications, as seen on imaging, that may indicate opioid misuse or opioid use disorder.
A literature search was conducted using the PubMed, Scopus, and Cochrane Library databases for articles related to imaging findings associated with chronic opioid use or misuse in orthopedic patients. Two independent reviewers conducted the search utilizing pertinent Boolean operations.
We reviewed 36 full-text articles and categorized the radiographic evidence of opioid misuse as follows: soft-tissue radiologic findings, cellulitis, necrotizing fasciitis, abscess formation, retained needles, discitis, myopathy and rhabdomyolysis, osteomyelitis, septic arthritis, and septic thrombophlebitis.
Knowledge of the radiologic findings of opioid misuse will assist orthopedic surgeons in making timely diagnoses that may alter therapeutic regimens for their patients.
Keywordsopioids orthopedic intravenous drug use imaging cellulitis abscess necrotizing fasciitis rhabdomyolysis osteomyelitis septic arthritis septic thrombophlebitis
Compliance with Ethical Standards
Conflict of Interest
Harry G. Greditzer IV, MD, Dustin H. Massel, MD, Carlos M. Barrera, BS, Christopher P. Emerson, MS, Michael G. Rizzo, MD, Nisreen Ezuddin, MD, Camila Brasil, MD, Ane Ugarte Nuno MD, and Jean Jose, DO, MS, declare that they have no conflicts of interest.
Human and Animal Rights
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2013.
Informed consent was waived from all patients included in this study.
Required Author Forms
Disclosure forms provided by the authors are available with the online version of this article.
- 7.Cheng YC, Lan H-CH, Shih CH, Chen CC, Lee SK. Magnetic resonance imaging of rhabdomyolysis: muscle necrosis versus ischemia. J Radiol Sci. 2013;(38):143–148.Google Scholar
- 9.Coskun-Ari FF, Bosgelmez-Tinaz G. grlA and gyrA mutations and antimicrobial susceptibility in clinical isolates of ciprofloxacin- methicillin-resistant Staphylococcus aureus. Eur J Med Res. 2008;13(8):366–370.Google Scholar
- 12.Flores EJ. Imaging and the opioid crisis: what you need to know about radiologists’ increasing role in the epidemic [interview]. 2018. ACR Bulletin. Available from https://acrbulletin.org/current-issue/1560-imaging-and-the-opioid-crisis
- 25.Massachusetts Department of Public Health. Data brief: opioid-related overdose deaths among Massachusetts residents, 2017. February 2018. Available from https://www.mass.gov/files/documents/2018/02/14/data-brief-overdose-deaths-february-2018.pdf
- 35.Seth P, Scholl L, Rudd RA, Bacon S. Overdose deaths involving opioids, cocaine, and psychostimulants—United States, 2015–2016. MMWR Morb Mortal Wkly Rep. 2018; 67:349–358. Available from https://www.cdc.gov/mmwr/volumes/67/wr/mm6712a1.htm
- 36.Shah A, Hayes CJ, Martin BC. Characteristics of initial prescription episodes and likelihood of long-term opioid use—United States, 2006–2015. MMWR Morb Mortal Wkly Rep. 2017;66(10):265–269. Available from https://www.cdc.gov/mmwr/volumes/66/wr/mm6610a1.htm CrossRefGoogle Scholar