Differential Diagnosis of Acute Limb Pain
| Tissue/structure | Features indicating disease | Possible pathologies |
|---|---|---|
| Skin and subcutaneous tissues | Swelling; oedema; discolouration; rash; blister, ulcer or abscess formation; tenderness; induration; crepitus; temperature difference; lymphangitis | Erysipelas Necrotizing fasciitis Hypersensitivity reaction to insect sting or bite Contact dermatitis |
| Arteries | Arterial pulses reduced or absent; prolonged capillary refill; ischaemic lesions of the hands or feet | Acute ischaemia |
| Veins | Superficial thrombophlebitis; localized tenderness over the deep veins | Superficial thrombophlebitis Deep vein thrombosis |
| Nerves | Reduced muscle power and tendon reflexes; impaired light touch and pin-prick sensation | Acute neuropathies including Guillain-Barré syndrome Acute radiculopathies Herpes zoster |
| Muscles | Localized or diffuse swelling or tenderness; reduced muscle power | Localized Strain injury (partial tear) Contusion injury (direct impact) Intramuscular haematoma Intramuscular abscess Tendon rupture Compartment syndrome Generalized Systemic infection Acute myositis |
| Joints | Swelling around the joint; presence of effusion; increased temperature of the joint; reduced range of movement; instability; tenderness | Meniscal or ligamentous injury Acute arthritis Acute bursitis Ruptured Baker (popliteal) cyst (may complicate rheumatoid arthritis or osteoarthritis of the knee) |
| Bones | Abnormal alignment (angled or rotated); localized swelling; localized tenderness | Subperiosteal haematoma Fracture Primary or metastatic cancer Infection Stress fracture Medial tibial stress syndrome Loosened hip or knee replacement Osteomyelitis |
Source: Oxford Clinical Diagnosis and Treatment eds Davey & Sprigings, OUP 2018. Reproduced with permission of Oxford University Press.