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

  • OPIOID PRESCRIBING AND PAIN MANAGEMENT / REVIEW ARTICLE
  • Published:
HSS Journal ®

Abstract

Background

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.

Questions/Purposes

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.

Methods

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.

Results

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.

Conclusion

Knowledge of the radiologic findings of opioid misuse will assist orthopedic surgeons in making timely diagnoses that may alter therapeutic regimens for their patients.

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Authors and Affiliations

  1. Department of Radiology, Hospital for Special Surgery, 535 East 70th St., New York, NY, 10021, USA

    Harry G. Greditzer IV MD

  2. UHealth Sports Medicine Institute, University of Miami Miller School of Medicine, Coral Gables, FL, USA

    Dustin H. Massel MD, Carlos M. Barrera BS, Christopher P. Emerson MS, Michael G. Rizzo MD & Jean Jose DO, MS

  3. Department of Radiology, Jackson Memorial Hospital, 1611 NW 12th St., Miami, FL, 33136, USA

    Nisreen Ezuddin MD, Camila Brasil MD & Jean Jose DO, MS

  4. Department of Radiology, Hospital Donostia, San Sebastian, Spain

    Ane Ugarte Nuno MD

Authors
  1. Harry G. Greditzer IV MD
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  2. Dustin H. Massel MD
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  3. Carlos M. Barrera BS
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  9. Jean Jose DO, MS
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Correspondence to Jean Jose DO, MS.

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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.

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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.

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Greditzer, H.G., Massel, D.H., Barrera, C.M. et al. Radiographic Musculoskeletal Findings Indicating Opioid Misuse: An Overview for Orthopedic Surgeons. HSS Jrnl 15, 84–92 (2019). https://doi.org/10.1007/s11420-018-09654-y

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  • DOI: https://doi.org/10.1007/s11420-018-09654-y

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