Joint Hypermobility and Pain Syndromes in Children
To be able to differentiate between inflammatory and non-inflammatory conditions.
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Susan Maillard and Clarissa Pilkington
Learning Objectives
1. To be able to differentiate between inflammatory and non-inflammatory conditions 2. To recognise that the symptoms related to the non-inflammatory pain conditions can be complex 3. To recognise that medical and surgical treatments are not effective and that the physical and psychological treatments are the most effective 4. Active participation in a self-management programme can control the symptoms extremely well
Case Vignette
A 12-year-old girl is brought to the general pediatric rheumatology clinic. Her family report that she has severe pain in her legs, and this prevents her from walking
S. Maillard, MSc, SRP, MCSP, Dip Physio (*) Pediatric Rheumatology and Musculoskeletal Pain Service, Great Ormond Street Hospital, London WC1N 3JH, UK e-mail: [email protected] C. Pilkington, MBBS Pediatric Rheumatology Service, Great Ormond Street Hospital, London WC1N 3JH, UK e-mail: [email protected]
sometimes, and she is not able to do sport or play with her friends. She is not attending school full time due to this pain. The family report that her knees have swollen up on several occasions when she has done some physical activity, but the swelling has gone by the next day. The local doctor is concerned that she has arthritis and has provided her with anti-inflammatory drugs and pain relief; however, this does not help her pain at all. On examination, she is a quiet young lady who reports pain immediately a hand is placed upon her leg. The examination of her joints reveals that there are no swellings or effusions; she has full range of movement in all joints and in fact is very flexible. On examination of muscle strength, she has good strength in her arms; however, many of her leg muscles are very weak. When she tries to demonstrate her walk, she is unable to effectively heel-toe and walks with increased flexion in her knees and hips with increased internal rotation of her hips.
Introduction In pediatric rheumatology clinics, it is very important that clinicians are able to differentiate inflammatory from non-inflammatory conditions.
© Springer Science+Business Media Singapore 2017 S. Sawhney, A. Aggarwal (eds.), Pediatric Rheumatology, DOI 10.1007/978-981-10-1750-6_45
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The physical therapy management of these conditions may be similar, but the medical (drug) management is completely different. Noninflammatory conditions frequently seen in pediatric rheumatology clinics include widespread musculoskeletal pain which may be linked to hypermobility (hypermobility syndrome)/EhlersDanlos syndrome, hypermobility type [1–3], widespread and localised musculoskeletal pain and complex regional pain syndrome. The conditions mentioned are benign and can be managed effectively with conservative methods; however, consideration of other conditions where hypermobility may be a feature is required. These conditions would include other forms of Ehlers-Danlos syndrome, Sticklers syndrome, osteogenesis imperfecta and Marfan’s syndrome [4].
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