Limb Pain in Childhood
David D. Sherry MD, FAAP1
1 Assistant Professor of Pediatrics, University of Washington, Director, Clinical Pediatric Rheumatology, Children's Hospital & Medical Center, 4800 Sand Point Way, NE, Seattle, WA 98105
Limb pain during childhood is common, and its causes range from the benign, such as joint hypermobility, to the potentially fatal, such as infection or tumor. Clues to the diagnosis are usually evident in the history, which can then give direction to the physical examination and, if necessary, laboratory investigations. Children with limb pain may be either ill or well (Table 1).
ILL CHILDREN WITH LIMB PAIN
Severe Joint Pain
The majority of ill children with severe limb pain experience an acute onset and may have associated symptoms, such as rash, fever, previous infection (especially skin infection, sore throat, or diarrhea), conjunctivitis, dysuria, or weakness (frequently interpreted by the family as tiredness). The severe nature of the pain usually renders the limb immobile or prevents even light weight-bearing. Erythema over the joint is an important sign because it is rare in chronic arthritic conditions (Table 2). The most important possible diagnoses include: infection, neoplasia, gastrointestinal disorders, rheumatic diseases, and cardiopulmonary disease.
Infection: Septic arthritis (with or without osteomyelitis) is the most common cause of severe monarticular pain. The absence of fever does not exclude a bacterial process. This is particularly true of septic sacroilitis and osteomyelitis of the pelvic and vertebral bones. Sudden onset of severe joint pain with marked swelling (and frequently erythema) is characteristic and typically involves the knee, hip, and ankle.
