Arm swelling can be a common manifestation of musculoskeletal, infectious, or rheumatologic diseases. The first consideration in a patient presenting with arm swelling is inquiry regarding a previous history of trauma. Traumatic events can result in injuries such as hematomas, sprains, and fractures. A clinician must also consider nonaccidental trauma in immobile children and in children presenting without a history to support a traumatic injury. Other potential diagnoses in patients presenting with arm swelling are infection and tumors. If more than one joint presents with swelling, consideration can be given to associated systemic diseases such as systemic lupus erythematosus, juvenile idiopathic arthritis, or inflammatory bowel disease. It is also very important to differentiate between conditions that might require urgent medical intervention.

• Presence of precipitating factors such as trauma or recent illness.

• For infants or patients presenting with an inconsistent history, nonaccidental trauma should be considered.

• Younger children who are not able to express pain may have a history of decreased use of the affected arm.

• Osteomyelitis, septic arthritis, and soft-tissue infections should be considered in patients who also present with subacute arm swelling, erythema, decreased arm movement, and fever. The most common bacteria in bone infections are Staphylococcus aureus and Group A streptococcus.

• Predisposing factors for soft-tissue infections include breaks in the skin from bites, abrasions, or preexisting skin conditions.

• It is common for distal radial, ulnar (Colles), greenstick, and buckle (torus) fractures to occur following trauma, such as falling on an outstretched hand, when a child is trying to protect himself/herself from a fall.

• Supracondylar fractures in children can be secondary to high-velocity injuries such as falling from a bicycle or playground equipment, such as monkey bars.

• Younger children usually sustain supracondylar fractures after shorter falls, such as fall from a bed or sofa.

• A ganglion cyst is a cystic swelling that can present as a nontender wrist mass. However, if it occurs near a joint, it can be painful.

• In the arm, osteochondromas are common benign, slow-growing, nonpainful, bone tumors that usually occur at the proximal humerus. Osteochondromas usually stop growing once the child reaches skeletal maturity.

• Children with a history of a bleeding disorder, such as hemophilia, may develop hemarthrosis or hematoma with minimal trauma.

• In a child with a history of a central venous line who presents with acute arm swelling, venous thromboembolism should be considered.

• 

Stay updated, free articles. Join our Telegram channel

Join