ABSTRACT
Acute limb pain is most commonly caused by arterial occlusion, deep vein thrombosis or cellulitis. A subacute or chronic course may be caused by chronic arterial or venous insufficiency, but may also result from metabolic bone disease, malignant bone infiltration or neuropathy. The mechanisms of limb pain may be summarised as follows: impaired arterial blood supply; impaired venous drainage; infection, inflammation or trauma; metabolic muscle or bone disease; neoplasia; and neuropathy. A cellulitic-looking leg with pain and/or systemic illness that is out of proportion to the clinical features should prompt consideration of more serious infections such as necrotising fasciitis, and referral for an orthopaedic opinion. Consider compartment syndrome if a limb that has recently undergone trauma or fracture develops disproportionate pain and/or symptoms and signs of ischaemia, such as paraesthesia, pallor, absent pulses, paralysis and cold peripheries.
