Acute painful joints

Musculoskeletal pain affects up to 20% of children at any one time, by far the majority of whom have minor or benign disorders. Deciding which patients have significant pathology is key. We consider the presentation of joint pain in four clinical settings: a child who is unwell with fever; a child who is well with mechanical joint symptoms or following trauma; a child with acute joint pain as part of a chronic condition; and a child with hip specific pathologies. This approach can help to formulate a differential diagnosis, guide appropriate investigations and institute effective treatment.