Acute and Non-acute Lower Extremity Pain in the Pediatric Population

Part III

Allison D. Duey-Holtz, MSN, RN, CPNP; Sara L. Collins, MSN, RN, CPNP; Leah B. Hunt, PA-C, MMSc; Polly F. Cromwell, MSN, RN, CPNP


J Pediatr Health Care. 2012;26(5):380-392. 

In This Article



A neoplasm is an abnormal growth of tissue that presents with new and uncontrolled proliferation of cells.

History of Present Illness.

  • Night waking pain

  • Limp

  • Systemic symptoms such as unexplained fevers, malaise, weight loss, fatigue, and loss of appetite

Physical Examination.

  • Diminished range of motion to affected/surrounding joints

  • Palpable mass

  • Tenderness in the affected area

  • Limp

Diagnostic Tests.

  • Radiographs of the entire long bone, including AP and lateral

  • CBC with differential because leukemia often presents with bone pain; the ESR often is mildly elevated, and the CRP level often is normal

  • A bone scan should be performed if the source cannot be localized

  • An MRI should be performed if a radiographic abnormality is seen or if the pain can be localized but radiographs are normal and the patient has an abnormal CRP or ESR value

Treatment. The patient should be referred to an oncologist or musculoskeletal tumor surgeon (based on local referral patterns) (Herring, 2008; Staheli, 2007; Staheli & Song, 2007).