Pediatric Musculoskeletal Complaints
Pediatric musculoskeletal concerns can be challenging for the clinician because of the age and communication ability of the patient. In addition, pediatric orthopedic conditions are of particular concern to parents and healthcare providers alike, as the p
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Pediatric Musculoskeletal Complaints K. Anjali Singh and Keith Gabriel
Pediatric musculoskeletal concerns can be challenging for the clinician because of the age and communication ability of the patient. In addition, pediatric orthopedic conditions are of particular concern to parents and healthcare providers alike, as the presence of growth plates leads to concerns about lifelong consequences to poor healing. There are certainly many pediatric conditions which are best cared for by pediatric orthopedic specialists, but many other conditions can be safely managed in the primary care clinician’s office. A reasonable general rule of thumb is to refer pediatric patients with musculoskeletal complaints that are potentially serious, difficult to diagnose, or involve joints or areas which are prone to poor healing or poor outcomes.
Red Flags 1. Suspected abuse. Children with multiple injuries, reported mechanisms of injury that do not seem to make sense, or suspicious injuries should be closely evaluated and followed up. Skeletal surveys can be used to determine the presence of past injuries, and if suspicion is high, social agencies or child protection services should be involved. 2. Refusal to use a joint/refusal to bear weight. A child who completely refuses to use a joint should be suspected of having a serious condition, such as fracture or a septic joint, until proven otherwise. These patients need careful evaluation to rule out serious pathology. 3. Musculoskeletal concerns in a child with poor growth or development. Patients with musculoskeletal complaints, who also have developmental concerns, are unusually small or large for age, or who have systemic symptoms should be carefully evaluated for the presence of systemic disease and metabolic/endocrine problems. K.A. Singh (*) Division of Orthopaedics, Department of Surgery, SIU School of Medicine, Springfield, IL 62794, USA e-mail: [email protected] J.M. Daniels and M.R. Hoffman (eds.), Common Musculoskeletal Problems: A Handbook, DOI 10.1007/978-1-4419-5523-4_10, © Springer Science+Business Media, LLC 2010
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K.A. Singh and K. Gabriel
This chapter deals with the most common pediatric musculoskeletal issues encountered in the primary care setting. Many excellent textbooks are available to cover a comprehensive review of pediatric musculoskeletal complaints. A list of suggested reading can be found at the end of this chapter.
Common Clinical Presentations Slipped Capital Femoral Epiphysis The “capital” femoral epiphysis refers to the growth plate of the femoral head. If the forces going through the hip are greater than the strength of the physis, the femoral head can slip off the neck, and hence the name slipped capital femoral epiphysis (SCFE). There are two main reasons for a slip to occur: (1) increased load across the joint (usually because of increased body weight, but can also rarely be from repetitive heavy lifting), and (2) weakened physis because of increased activity of the growth plates. SCFE is most common in children of ages 9–15 who have a
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