From the Guidelines
The medical workup for lower extremity pain in a 13-year-old female should begin with a thorough history and physical examination to identify the cause, including questions about pain characteristics, trauma history, and associated symptoms, as well as a physical examination to assess gait, range of motion, and point tenderness. Initial evaluation should include a detailed analysis of the patient's symptoms, including location, duration, and intensity of pain, as well as any aggravating or alleviating factors 1. A thorough physical examination should assess gait, range of motion, point tenderness, neurovascular status, and spine alignment. Basic laboratory tests, including complete blood count, erythrocyte sedimentation rate, C-reactive protein, and possibly vitamin D levels, are recommended to screen for inflammatory or infectious causes.
Initial Imaging and Diagnosis
Imaging should start with plain radiographs of the affected area, with consideration for MRI if symptoms persist or if a stress fracture, growth plate injury, or soft tissue pathology is suspected 1. A bone scan may be useful for detecting stress injuries not visible on X-ray. Common diagnoses to consider include growth-related conditions (Osgood-Schlatter disease, Sever's disease), overuse injuries (stress fractures, tendinitis), inflammatory conditions (juvenile idiopathic arthritis), and less commonly, infection or malignancy.
Management and Referral
Initial management typically includes relative rest, ice, anti-inflammatory medications (ibuprofen 10mg/kg/dose every 6-8 hours with food, maximum 600mg per dose), and physical therapy. Persistent or concerning symptoms warrant referral to pediatric orthopedics, sports medicine, or rheumatology depending on the suspected diagnosis. It is essential to consider the patient's age, symptoms, and physical examination findings when determining the appropriate course of action, as the differential diagnosis for lower extremity pain in a 13-year-old female can be broad and depends on various factors, including the presence of signs of infection, localization of pain, and history of trauma 1.
From the Research
Medical Workup for Lower Extremity Pain in a 13-Year-Old Female
The medical workup for lower extremity pain in a 13-year-old female may involve several steps, including:
- A thorough history and physical examination to identify the underlying cause of the pain 2
- Laboratory studies, such as complete blood counts, erythrocyte sedimentation rate, and C-reactive protein levels, to help diagnose conditions like osteomyelitis or septic arthritis 2, 3
- Diagnostic imaging, such as plain film radiography, magnetic resonance imaging (MRI), or computed tomography (CT) scans, to visualize the affected area and determine the extent of the condition 2, 4, 5
- Blood cultures to check for bacteremia, especially if the patient has a fever and acute lower extremity pain 3
Diagnostic Considerations
Some key diagnostic considerations for lower extremity pain in a 13-year-old female include:
- Osteomyelitis, which is an inflammatory condition of the bone secondary to an infectious process 4, 5
- Septic arthritis, which is an infection of the joint space 2, 3
- Bacteremia, which is the presence of bacteria in the blood 3
- Chronic pain-related disability, which may require physical therapy and rehabilitation 6
Imaging and Laboratory Tests
Imaging and laboratory tests that may be used to diagnose lower extremity pain in a 13-year-old female include:
- MRI, which has a higher sensitivity for identifying areas of bone necrosis in later stages of osteomyelitis 2, 4, 5
- C-reactive protein levels, which can be elevated in cases of osteomyelitis or septic arthritis 2, 3
- Erythrocyte sedimentation rate, which can be elevated in cases of osteomyelitis or septic arthritis 2
- Blood cultures, which can help diagnose bacteremia 3