Limb pain and swelling

Limb pain and swelling is one of the ‘top 20’ presentations in acute medicine. Patients present mainly with lower limb signs and symptoms, but upper limb presentations also occur and should be investigated and managed in a similar way. The causes can be divided into those producing bilateral changes, including fluid overload from cardiac or renal failure, low serum albumin or dependency oedema resulting from immobility, and those with primarily unilateral signs and symptoms that include disorders of the arterial, venous and lymphatic systems. An acutely painful limb, which can result from trauma, acute ischaemia or infection, is an emergency requiring urgent assessment and treatment, including surgical care. Other common presentations of limb pain and swelling include cellulitis, Baker's cyst and haematoma, and musculoskeletal pain caused by osteoarthritis or crystal and septic arthritis. Ambulatory (outpatient) management of stable patients with deep vein thrombosis or cellulitis is now the rule in most acute medical units with the use of low-molecular-weight heparin and novel oral anticoagulants increasing.