View source for Swollen extremity

Swollen extremity is a common ED presentation requiring evaluation for dangerous vascular, infectious, and musculoskeletal causes.

==Differential Diagnosis==
===Unilateral Upper or Lower Extremity===
*[[Deep venous thrombosis]]
*[[Cellulitis]] / soft tissue infection
*[[Abscess]]
*[[Compartment syndrome]]
*Fracture
*[[Septic arthritis]]
*Baker cyst rupture (posterior knee)
*Lymphedema (post-surgical, radiation)
*Venous insufficiency
*Post-thrombotic syndrome

===Bilateral Lower Extremity===
*[[Congestive heart failure]]
*Venous insufficiency (chronic)
*Nephrotic syndrome
*Cirrhosis
*Medication-related (CCBs, NSAIDs)
*[[Hypothyroidism]]
*[[Preeclampsia]] (in pregnancy)

===With Pain and Erythema===
*[[Cellulitis]]
*[[Necrotizing fasciitis]] - surgical emergency
*[[Gout]] / [[Pseudogout]]
*[[Septic arthritis]]
*[[DVT]]
*[[Compartment syndrome]]

==Evaluation==
*Assess for red flags: pain out of proportion, crepitus, rapidly spreading, hemodynamic instability
*Compare to contralateral extremity
*Unilateral leg swelling: apply Wells criteria, obtain D-dimer or compression [[DVT ultrasound|ultrasound]]
*If infection suspected: CBC, BMP, lactate, blood cultures if septic
*Compartment pressures if compartment syndrome suspected
*Joint aspiration if septic arthritis on differential
*X-ray if fracture suspected

==Management==
*DVT: [[Anticoagulation]] per protocol
*Cellulitis: [[Antibiotics]] (see [[Skin and soft tissue antibiotics]])
*Necrotizing fasciitis: emergent surgical consultation, broad-spectrum antibiotics
*Compartment syndrome: emergent fasciotomy
*Heart failure: [[Furosemide]], treat underlying cause

==Disposition==
*Admit for necrotizing fasciitis, compartment syndrome, septic arthritis, or sepsis
*Admit for severe cellulitis requiring IV antibiotics
*Consider admission for proximal DVT in high-risk patients
*Discharge with close follow-up for uncomplicated DVT on anticoagulation
*Discharge with PCP follow-up for bilateral edema with stable vitals

==See Also==
*[[Deep venous thrombosis]]
*[[Cellulitis]]
*[[Compartment syndrome]]
*[[Unilateral leg swelling]]
*[[Edema]]

==References==
<references/>

[[Category:Symptoms]]
[[Category:Orthopedics]]