Contents
History
- pain: CHLORIDE FPP (see the orthopaedic assessment)
- trauma, injury
- morning stiffness, limp, swelling/redness/warmth of joints
- general: fever, rash, fatigue, weight loss, cough, chest pain, back pain, hair loss, medications, voiding or stooling problems, iritis
- family history: arthritis, psoriasis, IBD, bleeding disorders, sickle cell anemia
Physical Exam
- complete physical exam; always examine joint above and below joint involved
- all joints: inspection, palpation, range of motion
- gait, leg length discrepancy
- tenderness over tendons or tendon insertion sites, swelling or nodularity
- muscle weakness or atrophy
- entheses- swelling, tenderness
Investigations
- CBC, differential, blood smear, ESR
- x-rays of painful joints/limbs
- as indicated: blood C& S, ANA, RF, PTT, sickle cell prep, viral serology, immunoglobulins, complement, urinalysis, synovial analysis and culture, TB test, ASOT, slit lamp
Differential Diagnosis of Limb Pain
|
Cause |
<3 years |
3-10 years |
>10 years |
|---|---|---|---|
|
Trauma |
X |
X |
X |
|
Infectious |
|
|
|
|
septic arthritis |
X |
X |
X |
|
osteomyelitis |
X |
X |
X |
|
Inflammatory |
|
|
|
|
transient synovitis |
X |
X |
|
|
juvenile idiopathic arthritis |
X |
X |
X |
|
seronegative spondyloarthropathy |
|
|
X |
|
systemic lupus erythematosus |
|
|
X |
|
dermatomyositis |
|
|
X |
|
HSP |
|
X |
|
|
Anatomic/Orthopaedic |
|
|
|
|
Legg-Calve-Perthes disease |
|
X |
X |
|
slipped capital femoral epiphysis |
|
|
X |
|
Osgood-Schlatter disease |
|
|
X |
|
Neoplastic |
|
|
|
|
leukemia |
X |
X |
X |
|
neuroblastoma |
X |
X |
X |
|
bone tumour |
|
X |
X |
|
Hematologic |
|
|
|
|
hemophilia (hemarthrosis) |
X |
X |
X |
|
sickle cell anemia |
X |
X |
X |
|
Pain Syndromes |
|
|
|
|
growing pains |
|
X |
|
|
fibromyalgia |
|
|
X |
|
complex regional pain syndrome |
|
|
X |