Pain may affect all or part of a leg or arm. Most disorders that cause limb pain affect the legs more commonly. Pain in the joints is discussed elsewhere (see Musculoskeletal Pain).
Limb pain may be constant or occur irregularly. Pain may be precipitated by motion or have no relation to movement. Other symptoms, such as warmth, redness, numbness, or tingling, may also be present depending on the cause of the limb pain.
Injuries and overuse are the most common causes of pain in a limb, but people usually know the cause of these injuries. This discussion covers limb pain unrelated to injury or strain. There are many causes.
The most common causes are the following:
Uncommon but serious causes that require immediate evaluation and treatment include
Other less common causes include bone tumors, bone infections (osteomyelitis), and nerve problems such as pressure on nerves or degeneration of nerves (such as caused by diabetes or long-term alcohol abuse).
It is particularly important to make sure the person does not have a sudden blockage of an artery because the limb can develop gangrene if there is no blood flow for more than a few hours. The following information can help people decide when a doctor's evaluation is needed and help them know what to expect during the evaluation.
In people with limb pain, certain symptoms and characteristics are cause for concern. They include
When to see a doctor:
People who have warning signs should see a doctor right away. People without warning signs should call a doctor. The doctor will decide how quickly the person needs to be seen based on the symptoms, age, and presence of other medical disorders. Typically, a delay of several days is not harmful.
What the doctor does:
Doctors first ask questions about the person's symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause of the limb pain and the tests that may need to be done.
Doctors look for symptoms that may indicate a cause of the pain. Some obvious findings may be very helpful in diagnosing the cause of limb pain. For example, back or neck pain suggests that a nerve root may be affected and fever suggests that the person has an infection. Shortness of breath and a rapid heart rate suggest blockage of an artery by a blood clot that has traveled from a leg to the lungs (pulmonary embolism). An irregular pulse suggests that the person may have a certain abnormal heart rhythm (atrial fibrillation) that has caused a blood clot to travel from the heart to block an artery in the leg.
The painful limb is inspected for color, swelling, and any skin or hair changes. The doctor also checks for pulses, temperature, tenderness, and crepitation (a subtle crackling sensation indicating gas in the soft tissue caused by a serious infection). Strength, sensation, and reflexes are compared between affected and unaffected sides. Blood pressure is measured in the ankle or wrist of the affected limb and compared with the blood pressure in an unaffected arm or leg. If blood pressure is much lower in the painful limb, it is likely that the arteries in the limb are blocked.
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Testing is not needed for all people with limb pain. Doctors can often diagnose some causes of limb pain, including cellulitis, myofascial pain, and painful polyneuropathy, based on the people's symptoms and the physical examination findings. Testing is usually needed for other possible causes of pain.
The best way to treat limb pain is to treat the underlying disorder. Analgesics such as acetaminophen and nonsteroidal anti-inflammatory drugs can help relieve pain. Sometimes opioids are needed.
Last full review/revision October 2012 by Lyall A. J. Higginson, MD