Skip to main content

Advertising Disclaimer »

Main menu

  • Journals
    • Pediatrics
    • Hospital Pediatrics
    • Pediatrics in Review
    • NeoReviews
    • AAP Grand Rounds
    • AAP News
  • Authors
    • Submit Manuscript
    • Author Guidelines
  • Content
    • Current Issue
    • Complete Issue PDF
    • Archive
    • Topic/Program Collections
    • Blog
  • Multimedia
    • Teaching Slides
    • Pediatrics On Call Podcast
  • CME/MOC
    • CME Quizzes
    • MOC Claiming
  • Subscribe
  • Alerts
  • Careers
  • Other Publications
    • American Academy of Pediatrics

User menu

  • Log in
  • My Cart

Search

  • Advanced search
American Academy of Pediatrics

AAP Gateway

Advanced Search

AAP Logo

  • Log in
  • My Cart
  • Journals
    • Pediatrics
    • Hospital Pediatrics
    • Pediatrics in Review
    • NeoReviews
    • AAP Grand Rounds
    • AAP News
  • Authors
    • Submit Manuscript
    • Author Guidelines
  • Content
    • Current Issue
    • Complete Issue PDF
    • Archive
    • Topic/Program Collections
    • Blog
  • Multimedia
    • Teaching Slides
    • Pediatrics On Call Podcast
  • CME/MOC
    • CME Quizzes
    • MOC Claiming
  • Subscribe
  • Alerts
  • Careers
American Academy of Pediatrics
Article

Approach to Acute Limb Pain in Childhood

Shirley M. L. Tse and Ronald M. Laxer
Pediatrics in Review May 2006, 27 (5) 170-180; DOI: https://doi.org/10.1542/pir.27-5-170
Shirley M. L. Tse
*Staff Rheumatologist, The Hospital for Sick Children; Assistant Professor, University of Toronto, Toronto, Ontario, Canada
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Ronald M. Laxer
†Vice President, Clinical and Academic Affairs, The Hospital for Sick Children; Professor of Paediatrics and Medicine, University of Toronto, Toronto, Ontario, Canada
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • Comments
Loading

This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.

Download PDF
  1. Shirley M. L. Tse, MD*
  2. Ronald M. Laxer, MD†
  1. *Staff Rheumatologist, The Hospital for Sick Children; Assistant Professor, University of Toronto, Toronto, Ontario, Canada
  2. †Vice President, Clinical and Academic Affairs, The Hospital for Sick Children; Professor of Paediatrics and Medicine, University of Toronto, Toronto, Ontario, Canada

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.

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

Table 1.

Differential Diagnosis of Childhood Limb Pain

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 …

Individual Login

Log in
You will be redirected to aap.org to login or to create your account.

Institutional Login

via Institution

You may be able to gain access using your login credentials for your institution. Contact your librarian or administrator if you do not have a username and password.

Log in through your institution

If your organization uses OpenAthens, you can log in using your OpenAthens username and password. To check if your institution is supported, please see this list. Contact your library for more details.

Purchase access

You may purchase access to this article. This will require you to create an account if you don't already have one.

Offer Reprints

PreviousNext
Back to top

Advertising Disclaimer »

In this issue

Pediatrics in Review: 27 (5)
Pediatrics in Review
Vol. 27, Issue 5
May 2006
  • Table of Contents
  • Table of Contents (PDF)
  • Index by author
View this article with LENS
PreviousNext
Email Article

Thank you for your interest in spreading the word on American Academy of Pediatrics.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Approach to Acute Limb Pain in Childhood
(Your Name) has sent you a message from American Academy of Pediatrics
(Your Name) thought you would like to see the American Academy of Pediatrics web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Request Permissions
Article Alerts
Log in
You will be redirected to aap.org to login or to create your account.
Or Sign In to Email Alerts with your Email Address
Citation Tools
Approach to Acute Limb Pain in Childhood
Shirley M. L. Tse, Ronald M. Laxer
Pediatrics in Review May 2006, 27 (5) 170-180; DOI: 10.1542/pir.27-5-170

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Approach to Acute Limb Pain in Childhood
Shirley M. L. Tse, Ronald M. Laxer
Pediatrics in Review May 2006, 27 (5) 170-180; DOI: 10.1542/pir.27-5-170
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
Print
Download PDF
Insight Alerts
  • Table of Contents

Jump to section

  • Article
    • Objectives
    • Introduction
    • Case 1
    • Septic Arthritis
    • Osteomyelitis
    • Transient or Toxic Synovitis
    • Case 2
    • Juvenile Idiopathic Arthritis
    • Lyme Disease
    • Growing Pains
    • Case 3
    • Slipped Capital Femoral Epiphysis (SCFE)
    • Legg-Calvé-Perthes Disease (Perthes)
    • Summary
    • Footnotes
    • References
    • Suggested Reading
  • Figures & Data
  • Info & Metrics
  • Comments

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Preparing Children for International Travel
  • Type 2 Diabetes Mellitus in Childhood and Adolescence
  • Ear Abnormalities
Show more Articles

Similar Articles

Subjects

  • Rheumatology/Musculoskeletal Disorders
    • Rheumatology/Musculoskeletal Disorders
  • Journal Info
  • Editorial Board
  • ABP Content Specifications Map
  • Overview
  • Licensing Information
  • Authors
  • Author Guidelines
  • Submit My Manuscript
  • Librarians
  • Institutional Subscriptions
  • Usage Stats
  • Support
  • Contact Us
  • Subscribe
  • Resources
  • Media Kit
  • About
  • International Access
  • Terms of Use
  • Privacy Statement
  • FAQ
  • AAP.org
  • shopAAP
  • Follow American Academy of Pediatrics on Instagram
  • Visit American Academy of Pediatrics on Facebook
  • Follow American Academy of Pediatrics on Twitter
  • Follow American Academy of Pediatrics on Youtube
American Academy of Pediatrics

© 2021 American Academy of Pediatrics