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(Pediatrics in Review. 2006;27:170-180.)
© 2006 American Academy of Pediatrics

Approach to Acute Limb Pain in Childhood

Shirley M. L. Tse, MD^*
Ronald M. Laxer, MD

^* Staff Rheumatologist, The Hospital for Sick Children; Assistant Professor, University of Toronto, Toronto, Ontario, Canada
Vice President, Clinical and Academic Affairs, The Hospital for Sick Children; Professor of Paediatrics and Medicine, University of Toronto, Toronto, Ontario, Canada

The first 300 words of the full text of this article appear below.

	Objectives

 
After completing this article, readers should be able to:

1. Recognize the clinical presentation of a septic joint.
   
2. Understand the pathogenesis and management of septic arthritis.
   
3. Discuss other causes of acute limb pain in children.
   
4. Develop an approach for the initial assessment and management of a child presenting with limb pain.
   

	Introduction

 
In a pediatric setting, physicians frequently are faced with a child presenting with acute limb pain. The differential diagnosis of acute limb pain may include a variety of causes (Table 1), each requiring differing treatments. In certain circumstances, the condition must be diagnosed immediately and appropriate therapy instituted quickly to prevent serious sequelae. Working through the cases discussed in this review offers an approach for the diagnosis and management of acute limb pain in childhood.

Table 1. Differential Diagnosis of Childhood Limb Pain

Infection/Infection-related Septic arthritis Osteomyelitis Reactive arthritis Rheumatic fever Lyme disease Toxic synovitis Trauma/Overuse Fracture Soft-tissue injury Osgood-Schlatter disease Hypermobility Malignancy Leukemia Neuroblastoma Bone tumors Hematologic Hemophilia Sickle cell anemia Inflammatory Juvenile idiopathic arthritis Systemic lupus erythematosus Henoch Schönlein purpura Orthopedic/Mechanical Slipped capital femoral epiphysis Legg-Calvé-Perthes disease Noninflammatory Growing pains Fibromyalgia Reflex sympathetic dystrophy Conversion reaction

	Case 1

 
A 13-month-old boy presents with a 3-day history of irritability and refusal to move his left leg. He had a cold 2 weeks ago and intermittent fever. He has no history of trauma, otherwise is in good health, and has received all of his immunizations. On physical examination, the boy has a fever (temperature, 100.4°F [38°C]); is nontoxic, although apprehensive and lying with his left leg held flexed and externally rotated; has no rash; has pain and decreased range of movement (ROM) of his left hip; has a normal left knee; and refuses to bear weight on his left leg.

The diagnoses of septic arthritis and osteomyelitis should be considered initially for any child presenting with fever and limb pain because they are medical emergencies that can result in rapid joint or bone destruction if not recognized and treated immediately. However, the differential diagnosis also includes other infection-related etiologies (eg, toxic synovitis, reactive arthritis, Lyme disease), malignancies, and inflammatory arthropathies (eg, systemic juvenile idiopathic arthritis [JIA]). Lyme disease . . . [Full Text of this Article]

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