Unexplained Musculoskeletal Pain in Children
- We are happy to see or advise on any unexplained musculoskeletal pain where clinical assessment and appropriate investigation fails to determine a cause. Pain in multiple sites rarely requires surgery.
- Most pains are ‘growing pains’ and have a fluctuating, indolent history with a healthy child and bilateral leg pains. These can give quite severe night pains that disturb the family. These do not cause limping.
- Pain in multiple joints/bones may be due to Juvenile Idiopathic Arthritis or (rarely) leukaemia. Referral to Paediatrics may be more appropriate particularly if there is a failure to thrive or joint swelling in keeping with inflammatory arthropathy.
- Many musculoskeletal pains are due to tightness and strain in the muscles or tendons as a child grows and gains weight in adolescence. Increased stress can also be placed on growing areas of bone where tendons attach (apophyses) whilst increased activity and sports training may also exacerbate pain. Examples include Jumper’s Knee (Osgood Schlatter Disease, Sinding-Larsen Johansson Syndrome, Patellar Tendinopathy, Achilles Tendinopathy, Sever’s Disease and Plantar Fasciitis). Such cases are self-limiting and will settle over time. There is no role for surgery. Where pain does not settle with a period of rest and activity modification, referral to physiotherapy may help.
- Anterior knee pain is commonly seen often in adolescents (especially females) with retropatellar pain worse on stairs and sitting for long periods (e.g. back seat on a long car journey). Physiotherapy is the best point of referral as long as hip rotation is normal.