Approach to Acute Limb Pain in Childhood

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.

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 …