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The periosteal gumma appears as a smooth, circumscribed swelling which is soft and elastic in the centre and firm at the margins, and shades off into the surrounding bone. The gumma may be completely absorbed or it may give place to a hard node. In some cases the gumma softens in the centre, the skin becomes adherent, thin, and red, and finally gives way.
The dead bone is separated from the living by the agency of granulation tissue with its usual complements of phagocytes and osteoclasts, so that the sequestrum presents along its margins and on its deep surface a pitted, grooved, and worm-eaten appearance, except on the periosteal aspect, which is unaltered.
"About twelve months ago, I examined the head of a cow, on the right facial region of which there existed an enormous tumor, extending from the eye to the lips, and which I mistook during life for a periosteal enlargement. On cutting into it, my mistake was evident.
On the other hand, resolution may occur during the stage of periosteal inflammation, or, an exostosis forms which causes no interference with function. Before there is evidence of an exostosis, diagnosis of ringbone is not easy, for it is then a problem of detecting the presence of a ligamentous sprain, periostitis, or osteitis.
When it affects the lower jaw, in its early stages, actinomycosis may closely simulate a periosteal sarcoma. [Illustration: FIG.
The lesion presents, on a small scale, all the anatomical changes that have been described as occurring in the medulla of the tibia or ulna, and they are easily followed in skiagrams. A periosteal type of dactylitis is also met with. The clinical features are those of a spindle-shaped swelling of a finger or toe, indolent, painless, and interfering but little with the function of the digit.
Evanescent periostitis is met with in acquired syphilis during the period of the early skin eruptions. The patient complains, especially at night, of pains over the frontal bone, ribs, sternum, tibiæ, or ulnæ. Localised tenderness is elicited on pressure, and there is slight swelling, which, however, rarely amounts to what may be described as a periosteal node.
X-ray appearances in periosteal tubercle: the surface of the cortical bone in the area of disease is roughened and irregular by erosion, and in the vicinity there may be a deposit of new bone on the surface, particularly if a sinus is present and mixed infection has occurred; in syphilis the shadow of the bone is denser as a result of sclerosis, and there is usually more new bone on the surface hyperostosis; in periosteal sarcoma there is greater erosion and consequently greater irregularity in the contour of the cortical bone, and frequently there is evidence of formation of bone in the form of characteristic spicules projecting from the surface at a right angle.
Tuberculous disease in bone is characterised by its insidious onset and slow progress, and by the frequency with which it is associated with disease of the adjacent joint. #Periosteal tuberculosis# is met with in the ribs, sternum, vertebral column, skull, and less frequently in the long bones of the limbs.
Innocent periosteal tumours retain the outer fibrous layer as a capsule. Malignant tumours tend to perforate the periosteal capsule and invade the soft parts.
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