#ortho #OSCE see also: [[pulled elbow]], [[paediatric limp]], [[bone and joint infection (paeds)]] [RCH upper limb non-use](https://www.rch.org.au/clinicalguide/guideline_index/Upper_Limb_NonUse/) >[!key points] >- most common causes for upper limb non-use in children and pulled elbow and fractures of upper limb and clavicle >- **Red Flags:** > - duration of sx >7 days > - systemic features (fever, night sweats, bruising, fatigue) > - neurological symptoms > - constiutional symptoms > - hx of other medical conditions eg bleeding dosorders, sickle cell # DDx - Trauma - Pulled elbow - 50% no hx of "pull" on arm - elbow in extension and the forearm in pronation - distressed only on elbow movement, esp pronation - marked resistance and pain with supination of forearm - upper limb fracture - pain and reluctance to use affected limb - swelling, tenderness, deformity - clavicle fracture - infection - septic arthritis - systemic features - severe localised joint/limb pain - hot, swollen, painful, immobile joint - osteomyelitis - systemic features may or emare not be present - subacute onset of refusal to use limb - limb may be poorly localised - malignancy - leukemia - bone/soft tissue - solid organ - brachial plexus neuropathy - juvenile ideiopathic arthritis - fever, rash - polyarticular arthritis - haematura - reactive arthritis - recent illness (pharyngitis, gastro, urethritis) - onset 1-2 weeks later - oligo/monoarticular arthritis, usually lower limbs - child abuse # management ![[Pasted image 20230826014859.png]]