HSS Journal ®

, Volume 15, Issue 1, pp 84–92 | Cite as

Radiographic Musculoskeletal Findings Indicating Opioid Misuse: An Overview for Orthopedic Surgeons

  • Harry G. GreditzerIV
  • Dustin H. Massel
  • Carlos M. Barrera
  • Christopher P. Emerson
  • Michael G. Rizzo
  • Nisreen Ezuddin
  • Camila Brasil
  • Ane Ugarte Nuno
  • Jean JoseEmail author



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.


opioids 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

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.

Supplementary material

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Copyright information

© Hospital for Special Surgery 2019

Authors and Affiliations

  • Harry G. GreditzerIV
    • 1
  • Dustin H. Massel
    • 2
  • Carlos M. Barrera
    • 2
  • Christopher P. Emerson
    • 2
  • Michael G. Rizzo
    • 2
  • Nisreen Ezuddin
    • 3
  • Camila Brasil
    • 3
  • Ane Ugarte Nuno
    • 4
  • Jean Jose
    • 2
    • 3
    Email author
  1. 1.Department of RadiologyHospital for Special SurgeryNew YorkUSA
  2. 2.UHealth Sports Medicine InstituteUniversity of Miami Miller School of MedicineCoral GablesUSA
  3. 3.Department of RadiologyJackson Memorial HospitalMiamiUSA
  4. 4.Department of RadiologyHospital DonostiaSan SebastianSpain

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