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osteoporosis described in adults, especially early after the onset of symptoms.
Radionuclide bone scans generally show increased blood flow and periarticular
uptake in adults, but in children with CRPS1 the blood flow and osseous uptake is
more often reduced. Thermography may document decreased temperature in the
affected extremity.
Management
Treatment of CRPS1 focuses on early mobilization of the extremity through
physical therapy to avoid atrophic changes. Physiotherapy may initially
exacerbate symptoms, but experienced clinicians believe it both prevents atrophy
and decreases the duration of pain. The knee-jerk response to splint for comfort
may be counterproductive with CRPS1. Referral to a pediatric pain program is
advisable if symptoms persist. Sympathetic block with local anesthetic is
commonly performed in patients with CRPS1 but evidence of effectiveness is
lacking. There are case reports of successful treatment of CRPS1 with
intravenous regional block using guanethidine, transcutaneous nerve stimulation,
and sympathectomy.
Suggested Readings and Key References
Osteomyelitis
McNeil JC, Forbes AR, Vallejo JG, et al. Role of operative or interventional
radiology-guided
cultures
for
osteomyelitis.
Pediatrics
2016;137(5):e20154616.
Peltola H, Paakkonen M. Acute osteomyelitis in children. N Engl J Med
2014;370(4):352–360.
Quick RD, Williams J, Fernandez M, et al. Improved diagnosis and treatment of
bone and joint infections using an evidence-based treatment guideline. J
Pediatr Orthop 2018;38(6):e354–e359.
Saavedra-Lozano J, Falup-Pecurariu O, Faust SN, et al. Bone and joint infections.

Pediatr Infect Dis J 2017;36(8):788–799.
Whyte NSB, Bielski RJ. Acute hematogenous osteomyelitis in children. Pediatr
Ann 2016;45(6):e204–e208.
Septic Arthritis
Carter K, Doern C, Jo C, et al. The clinical usefulness of polymerase chain
reaction as a supplemental diagnostic tool in the evaluation and the treatment
of children with septic arthritis. J Pediatr Orthop 2016;36(2):167–172.