Limb pain DDx

Limb pain – Differential Diagnosis

Common causes

• Soft tissue injury
• Muscle cramps
• Osteoarthritis
• Varicose veins
• Lumbar disc disease
• Gout
• Shin splints
• Complex regional pain syndrome

Must Not Miss

• Fracture
• Spinal cord compression
• Vascular
  • DVT
  • Acute ischaemia
  • Intermittent claudication
• Infections
  • Cellulitis
  • Septic arthritis
  • Osteomyelitis
• Compartment syndrome
• Malignancy
  • Bone tumours
  • Multiple myeloma
  • Metastases
• Rhabdomyolysis

Easily missed

• Medication (e.g. Statins)
• Polymyalgia rheumatica
• Vitamin D deficiency
• Ruptured Baker’s cyst
• Spinal canal stenosis
• Neuropathy

Red flags

• Bilateral leg pain with bowel/bladder dysfunction
• Cold pulse less leg
• Hot/painful/swollen joint with little movement
• Unilateral calf pain, swelling and tenderness
• Risk factors for DVT
• Swelling of the entire leg
• Severe progressive pain
• Systemic symptoms (fever, weight loss)
• Immunosuppression

Investigations to consider

• FBC, CRP/ESR, D-dimers
• U&Es, LFTs, Blood glucose,
• Serum uric acid, bone profile, CK, Vitamin D
• Local X-ray
• Duplex USS
• Venography
• Angiography
• Nerve conduction studies
• MRI scan